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1705 • 6 CITY OF CUP#RTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER 2 0 S� AND FOR , , LICANT TO FILL IN • CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION RQJECT: DEPARTMENT USONLY Legal Description: Tract..... 3B Block.........- Lot... __f....... �1 kj .H �........ Description of Work: _....... 1�...,ruC!t�l Plans Received BY..................ly..�%.....................Date . ..._�-_ .. ............................................................... ............... REO.: Plans.... Survey.... Celcs: Struc..... Energy.... Elect..... Mach.... tat Struct. Improvement on Parcel: Yes.... No... Area of Bldg............... Plans Checked By................................ .. ......Date ....... -.-. Separate Structure............ or Addition/Altergtion Exi t. Bldg ......... Application Approved By.................. .. ✓=_.,Date .�- ._!7��.!. No. of Stories......Z... Use Ild' s, „ Validated By................._................ ..........--.........Date ............ . .. _ -....... - Valuatio f Pro'ect: Compensation Certificate Verified B P Y .....r_.--.._. Date Owner: . ne:......... .. �6/cY� Ph one....... • • • E ,7�� Contractor: d. C}ty Bus. Lic. x .............. 00 Contractor's Adtlres38ur..;OJ.R7r /I.GX,.. Phonc{J7`/..-13.r/ Permit Fee (plus shalt f applicable) — Contractor - Electrical: .. ..:....................................... ... ....................... (P penalty PP ) ..Rct..I...._.....-,$.�.. ...�..._. City Business License #............. Phone:.................... Plan Check Fee (less deposit of $.......... Rct. #..........)$....................... Plumbin Energy Plan Check Fee (Dep. of $........ ROL #........)$................... g: ...................................................................................... -3 City Business License #...........__..... Phone:................... Strong Motion Fee ..........................................................$.......�.....� Heating and Cooling _ PlumbingPermit Fee $...... . .c..... ..._................. .....__......_......................... .............................................. -.. City Busi ebb Licgn a #......... .. Ph o e:.. ........ Electrical Permit Fee ....................................... $.... f... Architect/Desi nerS .7 .. - S� Mach. Htg./Coolg. Permit $............................. $.........._...i..OU g (sl 'P7a ...Zlfol Residential Construction Tax .............................'.........$....................... Engineer:T /'2„ . ......._..... Phone: 9 L . or: .. .. d ...A�'.Myic-d_........... .. ❑ Unknown Mise. Fee .............................................. ................... $...... "I certify that in the performance of the work for which this permit is Misc. Fee ........................................................................$.....-...-.......-..... issues I shall not employ any parson iWma es to become subtest • • . $ �/'3 r$�4 to the workman's 00th near law 8SIGNATURE OF ��//�� •-�zAP ANT/OWNER ... DATErz0M-,eS,- .Environmental Status: Exempt............ Other...............__............. ... .. ^I certify to as the apelican am the gLgvision ollthe Design Review Approval: Bldg. ............ Site ..........._ Sign ...-.-...... Contractors License Law and further that my Licens. No-A:W.4�S..l.. Use Zone P.D. Conditions In Classification .......... ............. ............ is in full force and effect: or Cond. Use Permit #............ Variance #............ Parking Spaces............ . . I certify that l am exempt from the "Licensed Required” provisions of the Approved B Contractors License Law. (Slate basis of exemption.) PP y........._...................................._....-..... Date ...._._......_.......... I hereby acknowledge that I have read this application and state that the above Is :arrect and agree to comply with all City Ordinances and State Laws regulating • - ' thudding. I (We) agree to save, indemnify and keep harmless the City of Cupertino ncroachment Permit........................ Grant of Easement........................ against liabilities, judgments, costs and expanses will nay in any way urb, Gutter, Sidewalk, Driveway: Replace.......-.- Repair.......... secure against said City In co qua e o e of this permI Sewer............ Conn. Fee $................ Water................ Meter $..............-. SIGNATURE of 7129DATE kgon Agreement for Completion of Public Works Improvements .............._.. APPUCA NT/CONTRACTOR ...... ..... DATE P.-.P�...Y`...- Plans Checked By........ Date........ Approved By........ Date.................... NOTE: when properly aced this to eonslilu as Building Permor it. This permit expires and becomes null and void should we not be commenced within APPLICATION • 140 days Iratn validation date, or should authorized construction be suspended in abandoned for a Period of 120 days eller work Is commenced. r PERMIT INSTALLATION NO. EACH FEE Light Ou .. _.. s .�A ... - APPLICATION FOR PLUMBING PERMIT Fixtures.[Z,... Receptacles.. L 0, PERMIT INSTALLATION NO. EACH FEES TOTAL NUMBER (less than 1000 watts) ..... . 7 $ ,50 Gas System with up to 5 outlets .................................$4.00 ............. Range../... Cooking Unit........ Oven....I...... ......1., ... 2.00 ......... . Each additional outlet ............................................. 1.00............... Dryer...I.. Garb. Disp..../.. Dishwasher I......... ... 2.00 ........ �� Water System I natal l ation, Alt. or Repair) ......... ..... 4.00............... MOTORS: 1 HP or less ...............I......................... .... . 2.00 -��• `� Water CIO eta Water F-reater.l.. Ld Tray-.-........ .... 4.oU Greater than 1 HP not more than 5 HP .............. . 3.50 .. ............ Lavatorw Shpwer Pan/. BathtubZ SinkZ.... ..... 3.00............... Temporary Power Pole or Service — 100 amp ..........5.00 _........ Wash. Mech..L Dishwasher/. Garb. Disp./. ...... ....... 3.00............... —200 amp......... 7.00 .............. Sewer ............ .0.g.B..Z_................................. ....... 8.00............... , Time Clock .................................... .................................. 1.50.......__...... Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00..................... ............. Mise. (see Ord. currentl........ ............................................. Vacuum Breakers ..................................._....... ..............3.50. ............. New Residentlel Occupancies let Rate 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 24.60 1751-.20000 37.60.............................. ...................................... 751-1000 26.00 2001-225C 39.50.............................. Permit Fee ..................................... ... ..... .........$6.00 1001-1250 28.60 2251-2500 42.00.............................. L121AL PLUMBING PERMIT FEE (plus penalty if app. Q) $ 1251-1500 32.00 2501-2750 49.50.............................. APPLICATION • . HEATING/COOLING PERMIT Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.0) $66 U0 PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M ..................... _r. .$ 6.00............... I INSPECTION ' - ' over 100M....................... . 10.00.. ........ Ap �,,• Comfort Cooling Unit......to 3 ton/HP ................. .......... 6.00..::'......... Forms / Foundation ......... .... .............. BY... ..... . Date:F`?0.� 1 to 15 ton/HP......................... 8.50.............. Plumbing Ground Work /-T^-Ir/,,,..... .. ........ .�^.'�l fr�/... ` a4 to 30 ton/HP........................ ..12.00..... Rough Electrical ............. .. ......... ..�.'. ..'. .. to 50 ton/HP...........................17.00.. .......... ram Plumbing an q 'Satin ........ ......_..... ../j.-.pZ..e _... 8.00 ation & Ener v \ Space Heater........ Wall Heater ...................................' .............. 9Y.............................. ......b ......... . ... V Flues - other than above ..................................... ...... 3.00.............. as Test . .......... ...._.. /�/�91. ....... Vent Fan: Kitchen........ Bath .,,�......._.........._.... 3.00... A7 ..... Y.Y/Y�:Gr....... Commercial R 0.00.............. Final - Else ...................... ........... ...... . ..... Q.[.b.�.. ...t ... a. Com Range Hood ................................... .1.... -. ..... Final din eC Misc. (See Ord. Current.................................... _..........L._._..................... g ..... ......... .... ......_. (s2.,1......>.$./ I Permit Fee ........................................................................ $ 0.00 +�) Final - eview / Landscaping . ... ..........._..........................__ TOTAL Htg./ Coolg. Permit Fee (plus penalty app. ❑) Final-Public Works ............................. . . . .....�..... . . ..