1790 (2) aT1N�
�rrr CUPE.
Cty�p(,EMEN �^d�
CITY OF CUPERTINO �AN
APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER
• AND APPLICANT TO FILL IN
CERTIFICATE OF OCCUPANCY 1P All FOR
BUILDING INSPECTION DIVISION STREET ADDRESS OF PROJECT:
_.10209...Byerly...Court. ........_........................_...... ._......
._.
DEPARTMENT USE ONLY Legal Description: Tract_6551- .- -.... Block.......... Lot.20_............
Descriptionof Work: ...._.._......................_....._....................._......._.......
Plans Received By....._............__ Date .....__......._......
REQ.: Plans.... Survey..-. Calcs: Struc..... Ener .................................. ent o..ar...ppei s.... N ��--......._...._Bldg............Energy.... Elect..... Meeh.... 1st Struct. Improvement on ParcBl: Yes.... No... Area of Bld
Piens Checked By_........_._............____....._........_Date ........ ........... 9...._....._..
Separate Structure__.._.0 or Addition/Alteration.. Exist. Bldg...........
Application Approved By....................___..............Date _..-......_.._.__... No. of Stories................ Use of Building
ValidatedB .................. ...............................
y......erti._..........erif..._....y ..................Date ....__................ Valuation of Protech $..._..._............_....__..._......_._._.._..._..........
_.......
Compensation Certificate Verified By ......_......... Date ..__........... Owner:
.. ...... ............._..........._.................._.............. Phone:...................
Contractor: ..._...BAS...HOMES,...1NC........City Bus. Lic. # .....
• $ Contractor's Address:
_...................._.................._.... Phone:.._ .............
..
Permit Fee (plus penalty if applicable) 24 ®0 Contractor - Electrical: ................_...._..._........_...... .__..._...................
Plan Check Fee (less deposit of$.-..._--- Ret. #._.......)$........_........ City Business License #................... Phone:......_...........
Energy Plan Check Fee (Dep. of $........ Rct. #........) $............ .... _... Plumbing: ........................................__......................................
,�U City Business License #,..............._.. Phone:....................
Strong Motion Fee ...................._..............._..-..............$... ..r......_.. Heating and Cooling .__._...
Plumbing Permit Fee ...._ ......_.._............ ..._.........................
. ..:...$.....__._........... City Business License #......._.._...._. Phone:........_..........
Electrical Permit Fee ......it $................................... Architect/Desi ner:
Meeh. Htg./Coolg. Permit $............................. $._......._........... 9 .. ............__ ....._........._........... Phone:....................
Engineer: ... ....._-..._............ . _
_... ................ Phone:..... ..__.......
Residential Construction Tax ...._._..-_..........._......_..._$..._....._.._..._.. Lender: ... .. ........... Unknown
Misc. Fee ...._............._.._..._..................._...._......_..... . ....._ ..___......._..........._........_._....
ISC, Fee .... ....._.._ $ .._.._ "I certify that in the performance of the work for which this permit Is
.._........ ................_.................._....... ..-.. ..._._. issued I shall not empi0y any person in any manner so as to become subject
• $
24.50 to the workman's compensation laws of California."
SIGNATURE OF
ZONING • APPLICANT/OWNER _........................................... ............. DATE..
.....................
nvNOnmental latus: Exempt............ Other..._.......... .-_................ .._ 'I cerrily 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 Licens, No. ............................
Use Zone P.D. Conditions .... ..................._.._._... ... in Classification .............._....... ......... : is in full force and effect: or
Cond. Use Permit #_...._... Variance #............ Parking Spaces............ .. I carnfy, 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
REQUIREMENTSPUBLIC WORKS correct and agree to comply with all City Ordinances and State Laws regulating
building.
�nC/08Chment Permit....................__ Grant Of Easement...._ 1we) agree to save, indemnify and keep harmless the City of Cupertino
.._.._.....;.. against liabilities, judgments. costs and expenses which may in any way
urb, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... accure against said City in Consequence of the granting of this permit.''
Sewer............ Conn. Fee $..._......-._. Water................ Meter $_.............. SIGNATURE OF
Agreement for Completion of Public Works Improvements ....__......._, APPLICANT/CONTRACTOR ....._.. ._.........._._................._........ DATE ....-_.................
Plans Checked By.,..... Date........ Approved By.......- .
Date... ...... NOTE: when properly Jalidaled this form constitutes a Building Permit. This
permit expires and becomes null and void should work not be commenced within
APPLICATION • ' ELECTRICAL PERMIT 120 days from validation dale. or should authorized construction be suspended or
abandoned for a period of 110 days after work is commenced.
PERMIT INSTALLATION NO. EACH FEE
Light Outlets............ Switches............ APPLICATI• O.
PLUMBING PERMIT
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..
.............
ryer........ orb. Dlsp......... 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 His ............_ . 3.50 -...._....... Lavatory_. Shower Pan.... Bathtub.... Sink................... 3.00..
Temporary Power Pole or Service — 100 am .---..-.
p ry p . . ..... .,5.00 .. .,_._,__,_ Wash. Mach..... Dishwasher_. Garb. Disp..... ..... _........ 3.00.
—200 am -.....---
p. ........ 7.00 .- _._.._... Sewer ..........._................_.....___.._._....._....................... 8.00...............
Time Clock ...__...-......................._.__........_...........4......., 1.50... ............ Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00.....................
.............
Misc. j see Ord. current 1............................ciesIiatHate ... .. Vacuum Breakers .............._...._..................... ..............3.50..............
P Interceptor........ Water Softener.._.... _...
New Residential Occupancies Flat Rate
........................4.00. ............
0-500 sq. ft. $22.00 1501-1750 $34.50......................... Plumbing Piping without fixtures ................................ 4.00.....
..........
"•••• Misc. (See Ord. Current) ...SQ az..pQzmi,X. 4,,.pp,,,,•,,,.•
501-750 24.60 1751-20000 37.50.............................. • ..
751-1000 26.00 2001-2250 39.50.............................. Permit Fee ............................................$6.00
1001-1250 28.50 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. (]) $
1251-1500 32.00 2501-2750 49.50.............................. APPLICATION FOR HEATING/COOLING PERMIT
PermitFee...............................................$6.00
TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.p) $ PERMIT INSTALLATION Q. EACH FEE
Forced Air Unit..................to 100M
INSPECTION • ' over 100M ....................... ........-$ 6.00...............
............... ......... 10.00.. ..........
Comfort Cooling Unit......to 3 ton/HP ..._.................... .. 6.00...............
Forms / Foundation ....._..-... ___.... ....... ... ...... .... . Date:................ to 15 ton/HP...__.................. 9.50..............
Plumbing Ground Work . ............ {..... .........._........_._.__...._....._. to 30 ton/HP....................._.�..12.00. ..........
Rough Electrical ..........._.........._...........J........_.._........... ............._.._........ to 50 ton/HP._..-.................. ..17.00.. ..
ame - Plumbing and Heating ..........I --- ....
...... .................
Space Heater........ Wall Heater ..................._......_..._. 6.00
sulation & Ener ..............
9Y....................._....._ .........._.._....._.(......_.........._....... Flues - other than above ._.._............._..._.......... .
.......I.. 3.00.. ............
as Test ............... ................... .... .. .I . . ................h'_. Vent Fan: Kitchen........ Bath .._........_....._.._............. .. 3.00...............
Temporary Power Gas / EIecI. .._.............................(...__....__........... Commercial Range Hood 6.00___--_. _„_„
Final - Electrical ....._......_.. �.. .. g ...................._......_... .
..... ..._._............................ Misc. See Ord. Current._.._...._..............._.... . .
Final - Building/Mechanical ........_... ( � . � �..............................._..
._........._........_L....._............... Permit Fee $ 6.00
Final - Design Review / Landscaping . .... ..... ........_... . ..._......__.....-..(plu......_.alty..if app. ❑) $
- --- TOTAL Ht / Cool Permit Fee
Final-Public Works ........................................................... g' 9� (Plus penalty Iy a