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1248CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT .AND AND CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION PlanaReceived By .................................................... Date ....... ................ REO.: Piano.... Survey.... CaIcs: Struc ..... Energy.... Elect..... Mach.... Plans Checked By Date .............. .--� Date Validated By .............................................................. Date Application Approved By ......... . ................... Compensation Certificate Verified By ................. Date ........................ Permit Fee (plus penalty if applicable) ........................ $ ... / .3_6,11 Plan Check Fee (less deposit of $.......... Rct. #..........) $ ....................... Energy Plan Check Fee (Dep. of $........ Rot. #........) $ ...................... Strong Motion Fee ..................ZT , ......... Plumbing Permit Fee ..........................:.- ... .�....... $......... .............. Electrical Permit Fee ............................. ................... $ ....................... Mach. Htg./Coo1g. Permit $ ....... $ ....................... Residential Construction Tax ............ . .. ......................... $ ....................... Misc. Fee ............................................ ..................... a ..... $................ Misc. Fee ............................................ ........................ _ $....t'0.......... .. $ 1q, .ra Environmental Status: Exempt............ Other ........................................ Design Review Approval: Bldg ............. Site ............ Sign ............ Use Zone ............ P.D. Conditions ............................................................ Cond. Use Permit Is............ Variance III ....... .... Parking Spaces............ ApprovedBy ........................................................... Date ........................... achment Permit ........................ Grant of Easement........................ IGutter, Sidewalk, Driveway: Replace.......... Repair.......... te .... ....... Conn. Fee $.. .............. Water................ Meter $................ Agreement for Completion of Public Works Improvements ................ Plans Checked By........ Date........ Approved By........ Date .................... PERMIT INSTALLATION NO. EACH I FEE Light Outlets............ Switches............ Fixtures............ Receptacles............ TOTAL NUMBER (less than 1000 watts) .. ... ...... $ .50 .. ........... Range........ Cooking Unit........ Oven .... __ .... ......... ... _ 2.00 ............. Dryer........ Garb. Disp ......... Dishwasher .................... 2.00 .. ..... .... MOTORS: I HP or less ................................................. 2.00 . ........... Greater than 1 HP not more than 5 HP ...... 3.50 .. ........... Temporary Power Pole or Se'rvice - 100 amp . ...... _5.00 .. ........... - 200 amp ......... 7.00 .............. TimeClock .............................. __ .. ........ ....... _ ... ...... _.. 1.50 ... ........... Misc. (see Ord. current ..................................................... 07_,� New Residential cup,a 0-500 sq. ft. $22.00 1501-1750 $34.50 ............................... 501-750 24.50 1751-.20000 37.50 .............................. 761-1000 26.00 2001-2250 39.50 .............................. 1001-1250 28.50 2251-2500 42.00 .............................. 1251-1600 32.00 2501-2750 49.50 .............................. PermitFee ...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty It app.Cj) $ Forms / Foundation .... __ .... _ _. _ , Plumbing Ground Work . ....... ........... A&gh Electrical .................................. We - Plumbing and Heating ......... lotion & Energy ............................. Temporary Power Gas / Elect. ....... Final - Electrical ........ _ .......... . ........... Final - Building / Mechanical ....... Final - Design Review / Landscaping Final- Public Works ................... PERMIT NUMBER FOR APPLICANT TO FILL IN STRgET ADDELESS OF PP.04EPT: ................... 'ira Legal Description: Block............ Lot..................... 4ernove Xcisting DeseVrition of Work- t.4T ... and ... g1;AyP1 Install ... n e . w . 'built ... up ... rooftng., ................ .......... . tat Struct. Improvement on Parcel: Yes.... No... Area of Bldg ............... Separate Structure............ or Addition/Altpration, to Exist. Bldg........... 1 . is Or rocitit No. of Stories ................ Lie uildr ....... qp_ ... �y ............................. �f 11 Valuationjf Proj, . .0 . .. .. . ..... 592 .... 3-96( Owner: . ... !?SfP.h. KOret. ii)r Taul5e Xs�Plhone: .......... 7... .... Contractor: Ace..RQ0f:Lng..Co ......... __ ... City Bus. Lic. 0 .............. Contractor's Address: P.-,Q-_BQW..520.6 ... S. -M, Phone3.417n7.411 Contractor - Electrical: ... ........... ............. _ ........... ...... ........................ City Business License.#.................... Phone:.................... Plumbing: .............. ..... _ .... .......................................................... City Business License 0 .................... Phone%. .................. Healing and Cooling . __ _ ....... __ .......... ........................ City Business License # .................... Phone:.................... Architect/Designer:................... ............... .............. Phone:.................... Engineer: .................... Phone:.................... Lender: .. ... ........................... .. C] Unknown 'I Certify that in the performance of the work for which this permit Is issued 1 shelf not employ any person in I b subject to the work pensation I� f gvrn IF URE0 APPLICANT.ATIL.... "I cort,fy that as the areptca am icanxwo up*d, prof the p Contractors License Law further I In 0.......77...44..7........... ....... in Class ........ rce nd effect; or pro I certify that I am exempt from the "Licensed pro Req ,ad" visions of the Contractors License Law. isles basis of exemption.) I hereby acknowledge that I have read this application and state that the above is :eupct and agree to comply with all City Ordinances and State Laws militlat g building. zno I (we) agree to save, indemnify and keep harmless the City of Cupert against liabilities, judgments, costs and a ... whigh mayIn anwa occurs against said Cit I onsequence t 0 grt.nayj of thin v it SIGNATURE OF gn AIMW@*WICON zo to NOTE: Who. property validaiml this I to It This 7.1d permit expires and becomes null must sh n= conernencid' within 12days from validation date, or should authorized construitlon be/susprinded at ba.cloned for a period of 120 days after work Is commenced. APPLICATION FOR PLUMBING PERMIT PERMIT INSTALLATION NO. EACH FEE Gas System with up to 5 outlets .................................$4.00.............. Each additional outlet ................................... ........ .. 1.00............... Water System (installation, Alt. or Repair) ....... ........ .. 4.00 . .............. Water Closet.... Water Fleeter.... Ld. Tray ........... ........ .. 4.00 . .............. Lavatory.... Shower Pan.... Bathtub.... Sink ........ ........ .. 3.00 .............. Wash. Mach..... Dishwasher.... Garb. Disp .... ..... ........ .. 3.00............... Sewer............. : ..................................................... . ........ .. 8.00 . .............. Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00 ........ ............. .............. Vacuum Breakers ................................ Interceptor........ Water Softener .....................................4.00............. I Plumbing Piping without fixtures ....................... ........ .... 4.00 . ............. Misc. (See Ord. Current) ......................................... ........... PermitFee .......................................................................... $ 6.00 TOTAL PLUMBING PERMIT FEE (plus penalty It app. :]) $ APPLICATION FOR HEATING/COOLING PERIVIII PERMIT INSTALLATION NO. EACH FE Forced Air Unit .................. to 100M ..................... ........... . $6.00----- ........... over100M ....................... .. 10.00 ... ........... Comfort Cooling Unit...... to 3 ton/HP * ................. ......... ... 6.00 .... ........... :. 6:00.:: to 15 ton/HP ** ............... .... 9.50 ... ............ to 30 ton/HP ........................... ... 12.00 .. ............ to 50 ton/HP ...... ........... ........ 17.00 .. ........... Space Heater........ Wall Heater ................................... 6.00 .... ........... Flues - other than above ..................... I ............... ........ 3.00.... ........... Vent Fan: Kitchen........ Bath .............. .... ... .. 3.00............... Commercial Range Hood .................. 6,00 ............ Misc. (See Ord. Current ....................... .... . ........ ...... ............... PermitFee ................. ............................... ...................... E 6.00 TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. C]) $