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1479 I CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBEAND R CERTIFICATE OF OCCUPANCY FOR APPLICANT TO FILL IN BUILDING INSPECTION DIVISION STREET ADDRESS OF PROJECT: 10183 Viceroy..Court...#1—&._112......_.._.................................. • • . • • Legal Description: Tract........................ Block............ Lot...................... Description of Work: ..Install--furnences-----------.--."- PlansReceived By....................................................Date ......................... -.............-............................................-........................-............................. REO.: Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach.... 1st Struct. Improvement on Parcel: Yes.... No... Area of Bldg............... Plans Checked By...""................................ ..........Date ........... ...... Separate Structure............ or Addition/Alteration to Exist. Bldg........... Application Approved BY........ .....1!�,<:�..L......Date ."�Q..� . ..� No. of Stories................ Use of Building .................. ............................... ValidatedBy..........................................:...................Date .............�..... Valuation of Project: $................................................................................ Compensation Certificate Verified By .................. Date ......_... ....... Owner: .....McCain......................_......._............... Phone:.................... Contractor: _.....-..............................................City Bus. Lic. x .............. • • • • • S Contractor's Address: ............._................................ Phone:.................... Permit Fee (plus penalty if applicable) ........................$....................... Contractor - Electrical: ...........................-................................................. Plan Check Fee (less deposit of$.......... Rct. #..........)$....................... e:. City Business License #.................... Phon ................... Energy Plan Check Fee (Dep. of $........ Rct. #........)$....................... Plumbing: ........................"..-....".-.............."..."".......................... Strong Motion Fee ..".......................................................$....................... City Business License #.................... Phone:.................... PlumbingPermit Fee ,,,,,,,...$....................... Heating and Cooling ...John. Dahl. . . .......... - -----.....--------..-- Cit Business License # Electrical Permit Fee ..........................................:..........$...................... Y 16k82....... Phone 1- Mach. Htg./Coolg. Permit $............................. $..18.-00 Architect: Designer: .................................................. Phone:.................... .. Engineer: .....-............................................... ." Phone:.............own Residential Construction Tax ..........................."............5:...........". ""' ""'�" - Lender: . ... ...............__........_......."._................................... ❑ Unknown . Mise. Fee ..............................................................."".......$....................... "I certify that in the performance of the work for which this permit Is Misc. Fee ........................................................................ ....................... issued I shall not employ any person in any manner so as to become subtest • $ to the workman's compensation laws of California." INNNESIGNATURE OF ZONINGAPPLICANT/OWNER ._..........._...................._.................................. DATE—................ Environmental Status: Exempt ............ Other..............._...................... .. .._.. I certily that as the applicant I am licensed unde' the provisions of the Design Review Approval: Bldg. ............ Site .""......... Sign ............ Contractors License Law and further that my Licari, No. .q . , 9 ..... Use ZOOS P.D. COnd111005 in Classification ............. ...._........... Is in full force and 0444.v ............ .""...................."."............................... Cord. Use Permit #............ Variance #............ Parking Spaces............ I certify that I am exempt from the "Licensed Required" provisions of the Approved B Contractors License Law. (State basis of exemption.) PP Y........................................................... Date .."........................ I hereby acknowledge that I have read this application and state that the above Is !orrect and agree to comply with all City Ordinances and State Laws regulating • • I building. I (We) agree to save, Indemnify and keep harmless the City of Cupertino roachment Permit........................ Grant Of Easement........................ against liabilities, judgments, costs and expenses which may In any way b, Gutter, Sidewalk, Driveway: Replace.......... Repelf.......... acture against said City InJcOgnn gyeltpe,of the granting of this permit." 411M ar............ Conn. Fee $................ Water................ Meter $................ SIGNATURE OF RR Unel Agreement for Completion of Public Works Improvements .................. APPLICANT/CONTRACTOR . 329. A.1ma. pA...9 303DATE -............._....... Plans Checked By........ Date........ Approved By........ Date.................... NOTE: when properly validated this form constitutes a Building PermO. This permit expires and becomes null and void should work not be commenced Within APPLICATIONFOR ELECTRICAL120 days from valitlalion dMa, or should authorized construction W wspslWM a Oilabendonetl for a period of 120 days after work is commenced. PERMIT INSTALLATION NO. EACH FEE APPLICATION FOR PLUMBING PERMIT Light Outlets............ Switches............ Fixtures............ Receptacles............ PERMIT INSTALLATION NO. EACH FEE TOTAL NUMBER (less than 1000 watts) ............ $ ,5o .......-- Gas System with up to 5 outlets .................................$4.00. ............. Range........ Cooking Unit........ Oven............ ................ 2.00 .............. Each additional outlet ............................................. 1.00. ............. Dryer........ Garb. Disp......... Dishwasher ............. ........ 2.00 .............. Water System (Installation, Alt. or Repair) .....-........... 4.00. ............. MOTORS: 1 HP or less ......................................... ....... . 2.00 Water Closet.... Water Heater.... Ld. Tray..................... 4.00.. ............. Greeter than 1 HP not more than 5 HP ............... 3.50 .............. Lavatory.... Shower Pan.... Bathtub.... Sink........................ 3.00... ............. Temporary Power Pole or Service — 100 amp ..........5.00 .............. Wash. Mach..... Dishwasher....Garb. Disp..... ..."............... 3.00. ............. —200 amp........" 7.00............... Sewer ........."..................................................................... 8.00............... Time Clock .................................................................... . 1.50... ............ Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00..................... ............. Mist (see Ord current)...................................................... Vacuum Breakers ............................................ ...3.50. . New Residential Occupancies Flet Rata Interceptor........ Water Softener......_ .........................-..4.00. ............ Plumbing Piping without fixtures ...................................4.00. ............. 0-500 sq. ft. $22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) .......... .......................................... 501-750 24.50 1751-20000 37.50.............................. Permit Fee ......"...................................................................E 6.00 751-1000 26.00 2001-2250 39.50.............................. TOTAL PLUMBING PERMIT FEE (plus penalty If app.Q) $ 1001-1250 28.60 2251-2500 42.00.............................. 1251-1500 32.00 2501-2750 49.50.............................. APPLICATION Permit Fee...............................................$8.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.p) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M ...t...................2... .$8.00----12:0 INSPECTION RECORD over 1o0M ...:.................... . 10.00.. ........... Comfort Cooling Unit......to 3 ton/HP ........................... 6.00,.. ............ Forme / Foundation ..................... ........ BY:.._.... ....... . Date:................ to 15 ton/HP........................ 9.50.. ........... Plumbing Ground Work ...................... I..... .......................................... to 30 ton/HP.......................... ..12.00.. ........... gh Electrical ....................................J... ..............--.............................. to 5o ton/HP................. .17.00.. ........... me - Plumbing and Heating ................................... ........................... Space Heater........ Wall Heater ................................... 6.00.. ........... teflon 8 Energy.............................. .................................................... Flues - other than above .................... Ouf 3.00.. ........... Test ............I--................ .... ... ........ ..................'....,..................... Vent Fan: Kitchen........ Bath ........................"................ 3.00... .......... Temporary Power Gas / Elect. . ................................. ........................... Commercial Range Hood 6.00,,, . Final - Electrical ............................................................. ........................... Misc. (See Ord. Current............................................... .......... ................. Final - Building/ Mechanical .............. .................................................. Permit Fee ....................... $ 6.00 ................................................. Final - Design Review / Landscaping . .- .........-.............................. TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. ❑) $ 18.00 Final-Public Works ...........................................................