1853CITY OF, CUPERTINO
CITY OF CUPERTINO I PERMIT NUMBER
APPLICATION FOR RESIDENTIAL BUILDING PERSAP♦N 2 /�S 3
AND FOR
APPLICANT TO FILL IN
CERTIFICATE
AND
OCCUPANCY PA
BUILDING INSPECTION DIVISION ST ET D RE F RO, T:
• • Legal Description: Tractiria.Ei.. Block............ L ..._.............
Description of Work:
t ... _............ 77,5~10—,11......- ................
Plane Received By ........................................... Date .........................
,.REO.: Plana.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach.... tat Struct. Improvement on Parcel: Yes.... No ... Area of Bldg...............
Gf'Plans Checked By.................................................. Data :.�..///,y ..p /J-� Separate Structure..... _.... or Addition/Alteration to Exist. Bldg...........
Application Approved By ................. ......... Date . rL.r7fvT..f._ No. of Stories..:Z___ Use of Building ... ............... ...... _--- .._..............
Validated By............................................................. Date ...................... Valuation I Project: $ ...
_-- ..........___................................... .......
Compensation Certificate Verified B .............._. Date ........._..............
Compo y Owner: ... h .Ott.... _. Phone'2'�..C7.S91
Contractor: ... It Bus. Lic. * .............
• • •' • $ Contractor's Atltlress: .. gq.YRRr Phone77%'./?-Y3fCt
(P penalty i applicable) ........................ $.........._........... Contractor - Electricals ... L................__..-................
Permit Fee jus enalt f a licable :jf s,
Plan Check Fee (less deposit of $.......... Rct. #..........) $....................... City Business L cef se *.. _.................. Phone:....................
Energy Plan Check Fee (Dep. of .......... Rct.#........$.......................
Plumbing: ..._....-.................. ...___................r..............................
Strong Motion Fee........................................................... $....................... City Business License *....... _........... Phone:............::......
PlumbingPermit Fee $.................... Heating and Cooling........... ...__........... .......... ..... --...............
....____..............._.................. City Business License #...___............ Phone:....................
Electrical Permit Fee...................... -- ......... ........ -........ $..� �L!d.......
• Mach. Htg./Coolg. Permit $............................. $....................... Architect: Designer: .... ........ ....... ............................... Phone:....................
Residential Construction Tax........................................ $ ....................... Engineer:.................................................-........... Phone: .......nkn..wn
........................................................................ .. ❑ Unknown
Misc. Fee............. ....._........_.......................................... $ ....................... Lender:'I certify that In the performance of the work for which this permit Is
---.....-....-.....-...--- - -----.--------. issued I shall not employ any person in any manner so as to become subject
Mist. Fee ................ $.
• . , , ; $ to the workman's c nsatl laws of California."
SIGNATURE OF
ZONING• APPLICANT/OWNER ............................... _.... _..........._.......... DATE ........................
Environmental Status: Exempt ............ Other..._................................... 'I corbly 1 as the applicant I am licensed uncle- the provisions of the
Design Review Approval: Bldg............. Site ............ Sign ............ camrncmm LiceL�Lw'ayfLJyfI er that my Licone. No. ................
Use Zone ............ P.D. Conditions.........................__............ in Classilicallon :Wag )........ is in full force and effect: or
................ .
Cond. Use Permit #.......... Variance #... --.... Parking Spaces............ I certify that I am exempt from the "Licensed Required" provisions of the
Approved By. Date Contractors License Law, (State basis of exemption.)
----^-- -- ---' - '- "-"-" """""""""""""' I hereby acknowledge that 1 have read this application and stale that the above Is
cotrrct and agree to comply with all City Ordinances and State Laws regulating
• • buildmp.
• I (We) agree to save, indemnify and keep harmless the City of Cupertino
ncroachment Permit.._................. Grant of Easement.................. against liabilities, judgments, costs a d expanses which ay in any way
urb, Gutter, Sidewalk, Driveway: Replace... ....... Repair.......... acture against said City In seq cWhe of this permit."
Sewer ....... Conn. Fee $.._............ Water. ... Meter $................ SIGNATURE OF
Agreement for Completion of Public Works Improvements .................. APPLICANT/CONTRACTO ATE ........................
Plans Checked By........ Date........ Approved By-..... Date.................... NOTE: when properly alidaled this formtling Parmll. This
permit expires and becomes null and void should work not be commenced within
• • 120 days from validation date, or should authorized construellen be suspended or
a abandoned for a period of 120 days after work is commenced.
PERMIT INSTALLATION NO. EACH FEE
Light Outlets............ Switches............ APPLICATION FOR PLUMBING
Fixtures............ Receptacles............ PERMIT INSTALLATION NO. 7=7 FEE
TOTAL NUMBER (less than 1000 watts) ._.......... $ .50 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..............
Greater 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... '7-". Sewer..................................................................... .......... 8.00...............
Time Clock........... ............... _....... ............ ....... ..... .... ..... 1.50...._........ Lawn Sprinkler Sys..$5.00 Ea. add Sys. $2.00..................... .............
Misc. (see Ord. current 1...................................................... Vacuum Breakers...... ..................... -............... ...3.50..
New Residential Occupancies Flet Rate Interceptor........ Water Softener.....................................4.00.............
Plumbing Piping without fixtures ............ ........... ........ ....4.00,,,,..,,,.,..,,
0-500 sq. it. $22.OD 1501-175D $34.50............. ................. Misc. (See Ord. Current) .........
501-750 24.60 1751-20000 37.50............ ....................................................
501-750 6•••••"'
• .................. Permit Fee.........................................................................$ 8.00
751-1000 26.00 2001-226C 39.50 .............................. p
1001-1250 28.60 2251-2500 42.00 ..............................
TOTAL PLUMBING PERMIT FEE (plus penalty If aDP• _) $
1261-1500 32.00 2501-2750 49.50 .............................. APPLICATION FOR HEATING/COOLING PERMIf
PermitFee...............................................$6.00
TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.0) $A PERMIT INSTALLATION NO. EACH FEE
Forced Air Unit..................to 100M ..................... .........$6.00 ...............
INSPECTION over 100M .......................... 10.00 ..............
Forma /Foundation ........._.._....... ..... BY:...-... Date:................ Comfort Cooling Unit...... to 3 ton/HP ..._.................... 6.00....
...........
Plumbing Ground Work .. ............... to l5 ton/HP ......................... 9.50..............
.... ............................................ to 30 ton/HP ................. .
Rough Electrical......._.......-.._..................._.._.............................-....... ....... .. 12.00.............
9 to 50 ton/HP ........................... 17.00..
rams -Plumbing and Heating.............................................................. 6.00 ...........
sulation 8 Ener Space Heater..han Wall Heater................-................ ..............
9Y.................................._...___._...... ............_............. Flues -other than above..................... ..... ........... ........1.. 3.00..............
asTest ...._._.._ ...............__.... .................._..............._..._...... Vent Fan: Kitchen........ Bath..... ..................__....:....... .. 3.00...............
Temporary Power Gas / Elect............................................................ 6.OD... ............
Commercial Range Hood................................... .........
Final - Electrical.........._......_.............. ............._--...... .... I...................... Misc. (See Ord. Current ,..................... ......_..-...... ...... ................ J........
Final - Building /Mechanical ............................................................. .... Permit Fee.................. ............. ...........--.......................... $ 6.00
Final - Design Review /Landscaping ................................................ TOTAL Htg./ Coolg. Permit Fee (plus penalty it app. ❑) $
Final- Public Works...........................................................