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1704" dih iCITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION Plans Received By ................... _/(Z.7 .................. Date S3/.�/ _ .... REO.: Plans.... Survey.... Cates: Struc ..... Energy.... Elect..... Mach ... Plans Checked By Date Application Approved By. 4.r-'. .;'.. Date Validated By .............................................................Date Separate Structi ............ or Addition/Alta ion E ' I yi�o %B dg ,e . . No. of Stories.......... Uti Buildin Ym e .... Compensation Certificate Verified By ...... Date Contractor - Electrical:........_ ........ . City Business License # ....... ... Phone:..........._....... "Wermit City Business License # ............ ........ Phone: .................... Fee (plus penalty if applicable) .......... Plan Check Fee (less deposit of $...... Piet. # .......... ) $ . ............. Energy Plan Check Fee (Dep. of $...... Fell. # ........ ) li StrongMotion Fee .............. - ....................... .......... _ $ ......... Plumbing Permit Fee ................................................ Electrical Permit Fee ...................................................... Mach. Htg./Coolg. Permit $ ............................. building. r Residential Construction Tax ....................... _ ..... - ....... $....................... .Misc. Fee ........................ ........ ___ ............................... $....................... Misc. Fee ............................ ....... _ ............................ $....................... permit expires and becomes null and void should work within or, 120 days from validation date, or should authorized construction be suspended or abandoned for a period of 120 days after work Is commenced. APPLICATION FOR PLUMBING PERMIT Environmental Status: Exempt............ Other..._............................. Design Review Approval: Bldg. . ........... Site ............ Sign ............ Use Zone ............ P.D. Conditions ............................................................ Water0 eta.Water R7ater I Ld Tri . ..... 4.00. 116.A". Cond. Use Permit A,,,,,....... Variance +M............ Parking Spaces............ ApprovedBy ........................ - .... ....... ....... ........ ... Date ........................... xx PUBLIC WORKS REOUIREMENTS Interceptor........ Water Softener ........ ... ........ 4: 1'� . ...... -- I roachment Permit ................ Grant of Easement........................ b, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... epair...--- "�' ewer ewer ......... ... Conn. Fee $ ................ Water................ Meter $................ Agreement for Completion of Public Works Improvements .................. Plans Checked By........ Date ........ Approved By........ Date .................... PERMIT INSTALLATION Li ht0U 19.... Switchett Fixtures. TOANUMBER (less than 1000 watts) RangeA .... Cooking Unit ........ Oven...)....... ..... .. NDryer..J ... Garb. Disip ... I .... Dishwasher ./ . MOTORS: 1 HP or less .................................. Greater than 1 HIP not more than 5 HP ...... Temporary Power Pole or Service 100 amp 200 amp EACH $ .60*2 1 1 2.00 r',, 2.00 2.00 . .... . 3.50 .. ........... .5.00 7.00 I,., Time Clock ............ ............. - ....... ............... ....... . 4--4, 1.50 ... ........... tAMisc. (see Ord. current) ...................................................... I . New Residential Occupancies Flat Rate V 500 . ft. $22.00 1501-1760 $34.50.. -750 24.60 1751-20000 37.50 .............................. 26.00 2001-225C 39.60 ............................. 0 28.60 2251-2500 42.00 .............................. 0 32.00 2501-2760 49.50 .......... : ................... Permit Fee ...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.0) $710,XV • Forms / Foundation...... I . __ . By:� Datelau..2tlj Plumbing Ground Work .................. o,ugh Electrical .................. Plumbing Ei Eeafi5n) 1 .10 ... ...... . I ton & Enprgy Test o ............ ...... ... ......... ....... Final - Electrical Finalti�i vlec anical . -_ Final - Design Review / Landscaping Final -Public Works ................... PERMIT NUMBER FOR APPLICANT TO FILL IN STIR 7 E WWF PVqT: I Y/�,_X. A14-0 ............. ..... Legal Description: Lpt ... Description of Work: _. 1. 11910 .. ............... ........ .............. ....... .................. . ................ ................. 1st Struct. Improvement on Parcel: Yes.... No.... Area of Bldg ............... Separate Structi ............ or Addition/Alta ion E ' I yi�o %B dg ,e . . No. of Stories.......... Uti Buildin Ym e .... f Projet: ...... Valuatio Aezi U. 05 i5lfi Phone: ..... Con , 0 'ty Bus. Lie. # Contractor's AddtF Phone:779-/39J Contractor - Electrical:........_ ........ . City Business License # ....... ... Phone:..........._....... Plumbing:.. _ ... ........ .... .. . ... City Business License # ............ ........ Phone: .................... Heating and Cooling .... ....... .. ....... .. . ....... . ...... City Ci B U ss to 'i Architect/De� �A U. st g� Engineer: 7 i� Phoned eic ' ;*f ...-A - __ ...... ... ............ .. [] Unknown W. "I certify that in the performance of the work for which this permit is issued I shall not employ any person In any reamer so as to become subject to the workman's c penes a law of C SIGNATURE OF APPL ANT/OWNER ....... DATEV�-16?.-A 'I certify I at as the applicant I am heWn..dnd, the p . a Contractors License Law further and that in Classification ....... ......... ... .... ............ is in full force and effect: or I certify that I am exempt from the "Licensed Required" provislorts of the Contractors License Law, (State basis of exemption,) I hereby ackrm,vledgo that I have read this application and stale that the above is correct and agree 10 comply with all City Ordinances and State Laws regulating building. I (We) agree to save, Indemnify and keep harmless the City of Cupertino a against liabilities, judgments, costs and which anti expo see w to may in any way --- �Xe occurs against aId City In 0 6 0 1 of this permit" �Coeque SIGNATURE OF APPLICANT/CONTRACTOR � A 5.1ab.11ccommenced rif dated this I NOTE: When properly dated This for .811h.ter, RuildlTng Permit. This or, 1 permit expires and becomes null and void should work within or, 120 days from validation date, or should authorized construction be suspended or abandoned 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- ...... . .. .. $4.00.. .... ... . Each additional outlet - .......... r' ............ 1.00.... ' Water System (Installation, Alt. or Repair) 4:00 Water0 eta.Water R7ater I Ld Tri . ..... 4.00. 116.A". LavatoryShower Pan.. 13J&1bZ. 6 3.00-1 Wash. Mach../. Dishwasher.. Garb. DIE 3.0 a. Sewer _........../,0..V/ ..... ___ ................ . . . ... .. 8.00, Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00 ........ ..................... ...... Vacuum Breakers ................. .................... .'': , Interceptor........ Water Softener ........ ... ........ 4: 1'� . ...... -- I Plumbing Piping without fixtures ...................... ........ .... 4.00 . ............. . Misc. (See Ord. Current) .................................................... I PermitFee .............. .......... ............ ................................... $ 6.00 TOTAL PLUMBING PERMIT FEE (plus penalty If app. 0) $ .16l1 APPLICATION FOR HEATING/COOLING PERMIT 0 - PERMIT INSTALLATION 1 NO. TArH-- TET Forced Air Unit ..................to 100M ..................... ... I... .$ 6.00,.. 4-4to over100M ................. ........ . 10.00 .............. Comfort Cooling Unit ...... to 3 toll ................. ........ .. 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 �z3 above ..................................... 00 Vent Fan: Kitchen...0.. 0.. Bath ...........................W, O�['A'�j!' Commercial Range Hood .......................-.........../..J... Misc. (See Ord. Current.............. .......................... ........ .. .. ......... ............ Permit Fee ............. ...... __ .... _ ................. - ....... ............... $ 6.00 TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. 0) 111 . ,3 0`0 ............................ .... ? I 01 �� IWbiit 'S.K. 3-1 1 -t41 11 go I iieKr NO