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1624 • GS'�I G• �y'.'TlltO CITY OF. CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT r / PERMIT NUMAND BER �� 2 CERTIFICATE OF OCCUPANCY FOR APPLICANT TO FILL IN BUILDING INSPECTION DIVISION STREET DDR SVCF PRO ECT: VALLGO FA-SHlor,l'�A IO.I.Z.�✓.... ..I�Y2.G. ....ROAb..)... FAC.E.*.4............ DEPARTMENT USE ONLY Legal Description: Tract...... .. ... Block............ Lot............... .. Plans Received By Desc iptio of Work: .4V. . .....-..16.ISTAk6..MA..�f-�. ..:'.l}....AI (� y....................................................Date ......................... >-fau.........iNraK ...Qvcrlu.oK..o(,).... 00e...... REQ.: Plans.... Survey.... Celcs: Struc..... Energy.... Elect..... Mech.... 1st Struct. mprovement on Parcel: Yes.... No.... Area of Bldg............... Plans Checked By............................. Date ..... ... . Separate Structure............ or Addition/Alteration to Exist. Bldg........... Application Approved B �. // fG No. of Stories......... Use of Building PP PP Y................... ..4.- ............Date ........ ...... ..� ValidatedB .. _.... g ....--.......... ............................... By..............................................................Date ........ ....... ... Valuation of Project: $.... .............-.......................- ............................... Compensation Certificate Verified By ................. Date .............. Owner: Contractor: ._............ ........._.............................City Bus. Lic. # _ ........... • • •• • $ Contractor's Address: ........................ ........ Phone:.................... Permit Fee (plus penalty if applicable) $....................... Contractor - Electrical: ................................._......................................... Plan Check Fee (less deposit of$.......... Rot. #..........)$....................... City Business License #.................... Phone:.................... Energy Plan Check Fee (Dep. of $........ Rot. #........) $.....-............... Plumbing: ........----.......................-....................................- -.. Strong Motion Fee ..........................................................$...................... City Business License #.......... ....... Phone:................-... Plumbing Permit Fee ................................................ _ $_.... .........-..... Heating and Cooling Electrical Permit Fee .......... ..............................._....... $..... City Business License #..I6. Q3 Phone:.'3 6-.Q.7 O ............... Architect/Designer: .. ............................................... Phone:.................... Mach. Htg./Coolg. Permit $............................. $..... .i.0'0....... Engineer: ... .. ..... ._-.................._......_.................... Phone:.................... Residential Construction Tax .......--...-...........-...........$....................... Lender: Unknown Misc. Fee .............................._........................... ... ........................... ..............._............................ Misc. Fee $ .., "I certify that in the performance of the work for which this permit Is ........................................................................ ...................... issued I shall not employ p y an y person f any manner so as to become subject • $ to the workmen's compensation laws of Celilornle." SIGNATURE OF •=40791111117,17. E APPLICANT/OWNER .......... ............._-.........._........__................. DATE........................ Environmental Status: Exempt ............ Other..................... 1 certify that as the applicant I am licensed unde the pro I}}}�'gQgQs�,..,vof th¢¢ Design Review Approval: Bldg. ............ Site ............ Sign ............ Contractors License Law and further that my Licens, No, ..r.71.j.4{.Z7 Use Zone ..........- P.D. Conditions ............_...... .................. in Classification .... Is in full force and effect: or C 20 C3(a Cord. Use Permit #............ Variance #._......... Parking Spaces............ . . I certify that 1 am exempt rom 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 stele that the above Is _ anrrect and agree to comply with all City Ordinances and Stale Laws regulating • building. 1 (We) agree to save, indemnify and keep harmless the City of Cupertino roachment Permit........................ Grant of Easement........................ against liabilities, judgments, costs nd expenses which may In any way Gutter, Sidewalk, Driveway: Replace.......... Repalr.......... .secure against said City�cnseq ce of thegranting of this permite r............ Conn. Fee $................ Water................ Meter $-.............. SIGNATURE OFAgreement for Completion Of Public Works Improvements .._.............. APPLICANT/CONTRACT DATEPlans Checked By........ Date--.... Approved By........ Date.................... NOTE: when properly vel form constitutes a Building Permit. This permit expires and becomes null and void should work not,be commenced within APPLICATION •• ELECTRICAL PERMIT 120 days train validation date, or should authorized canalNctlon be suspended or abandoned for a period of 120 days after work Is commenced. PERMIT INSTALLATION NO. EACH FEE APPLICATION • • PLUMBING PERMIT Light Outlets............ Switches.......... . Fixtures............ Receptacles............ PERMIT INSTALLATION NO. EACH 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.OU. ............. 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............... Sewer .....................-..................-................................... 8.00............... Time Clock ..............................-.... .......................... ....... . 1.50........._..... Lawn Sprinkler Sys. $5.00 Ea. add sys. $2.00..................... ............. Misc. (see Ord. current)... .............. ........ ................. .. Vacuum Breakers ._............................... .. ............3.50.............. New Resltlential Occupancies Flat Rate Interceptor........ Water Softener........ .............................4,00. ..--........ Plumbing Piping without fixtures ...................................4.00............... D-600 aq. ft. $22.00 1501-1750 $34.60.............................. Misc. (See Ord. Current) .......................... 501-750 24.50 1751-20000 37.60.............................. """'••"•'•'•'••••••••• 761-1000 26.00 2001-226C 39.50.............................. Permit Fee .................-........................................................$6.00 1001-1250 28.50 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty If app. 0) $ 1251-1500 32.00 2501-2750 49.50..................... APPLICATION FOR HEATING/COOLINC PERMIT PermitFee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.p) $ PERMIT INSTALLATION 1NO. EACH ' FEE Forced Air Unit..................to 100M ..............................$6.00............... ' RECORD' over 100M ........................ . 10.00.. ........... Comfort Cooling Unit......to 3 ton/HP ...............- .......... 6,00... ........... Forms / Foundation ................... ...... . BY:..... .. . ..... . Date:................ to 15 ton/HP......................... 8.60.............. Plumbing Ground Work . .. ................ ..............1............ Rough Electrical ................................................ to 30 ton/HP...........................12.00. ............ .. ..................................... to 50 ton/HP........................... 17.00.. ........... 'rams - Plumbing and Heating ................................... ........................... Space Heater........ Wall Heater .......................-.......... 6.00.. .......... lotion & Energy.............................. .................................................... Flues - other than above ............................................�.. 3.00.............. Test ,Mw ..............Grua...........-.. ....... ... .... ..................- Vent Fan: Kitchen....H Bath ............................... ....... .. 3.00............... i porary Power Gas / EIecL ....... ..._............_......._........ ............... Commercial Range Hood _...... ..._..... ... 8.00,,,. Final - Electrical .........._........�__._..._.... ............._......... ........ MiacPerrmitt e Cugrrent......................................................... M'Id..1�P....� .a,Y....._ePP. O... 6.00 0b Final - Building /Mechanical .................................................................. Final - Design Review / Landscaping . ....- .....__.............._................. Final- Public Works ........................................................... TOTAL Ht / Cool Permit Fee r