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1703 (2) CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER AND CERTIFICATE OF OCCUPANCY FOR APPLICANT TO FILL IN BUILDING INSPECTION DIVISION x 7.ST 'T OV?E F PRO�JECT. 1.�.... . . . .............. DEPARTMENT USE ONLY Legal Description: Tree Bloc ........ Lot �bescription ............­ Plans Received By.......... ... ........ .................Date ......................... I . ........ .... .. ... .... .. . .. . .. ................. REQ.: Plans.... Survey.... Cafes: Struc..... Energy.... Elect..... Mach.... 1st t r u ct Improvement o n Parcel:. .. 1 YesI . N.o_ Area... ..o.I.-Bldg................... Plans Checked By....................... Date Separate Structure............ or Addition/Alteration to Exist. Bldg........... Application Approved By.............;q /. . ............. ... ......... ...Date .0A. No. of Stories........._.._. Use ol Bu�'di Validated By............................................... Date V iltg ......... ...................... /Valuation ol-Projeei: .................. ................................ Compensation Certificate Verified By ................. Date Owner: ...17 1_._! 464A Phone:..... lContractor: VAJICY. .. .... UOPLCQ_�9_1�§Cjtt Bus Lic. $ �Contractor'S Address:if.;l : . Kq..... Phone::.Z-'.'� rl Permit Fee (plus penalty if apIRPI(d., Contractor - Electrical: ....... ........__........... ........ ........................ City Business License #.... ............ Phone:.................... Plan Check Fee (less deposit of FahkR---Tt'N­ -?*now- Plumbing: .......... ......................__...................... Energy Plan Check Fee (Dep f $........ net. # ..0$ Strong Motion F $ .iff.... City Business License #.... ..... Phone:.................... $...1..,.'.....:...... .n..._ Plumbing Permit Fee ............. $ -/d............. Heating and Cooling ...... ........ ................... Electrical Permit Fee ........................... ... . $......7.,_,00..... City Business License n................._.. Phone%..... ......... Mach. Htg./Cootg. Permit $........ Architect/Designer: .. _..... . .. ........ ...... Phone:.................... Residential Construction Tax ... _.PAID......... $ ...... Engineer: ........ .......... .... ___..............__ _.... Phone:.................... ............ ............$..........._.........' Lender: .. ..... ..... ... ...... ..................... . ED Unknown Misc. Fee ................._....................._.........................$ Misc. Fee ...................................................­...............­$ certify that in the performance of the work for which this permit Is issued I shalt not employ any person In any manner so as to become subject to the workman's compensation laws of California," SIGNATURE OF APPLICANT/OWNER ......... ...... ..................... Environmental Status: Exempt ............ Other.................................. 'I certify that as the applicant I am licensed unde the I the y alf 6... Design Review Approval: Bldg. ............ Site ............ Sign ............ Contractors License L P.!?Ve Use Zone ............ P.D. Conditions .......................................................... in Clm VV_. is in full (area and effect: or - Cond. Use Permit n..._....... Variance a......._... 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 I have read this application and state that the above Is correct and agree to comply with all City Ordinances and State Laws regulating building I (We) agree to save, indemnify and keep harmless the City of Cupertino incroachment.Permit.-...................... Grant of Easement....................... against liabilities, judgments, costs and expenses which may In any way eurb, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... secure against said City In consequence the granting of this permit." Sower....... ... Conn. Fee $................ Water................ Meter $................ SIGNATURE OF ro Agreement for Completion of Public Works Improvements .................. APPLICANT/CONTRACTO'Rei2S,.tlA,,,.�.e..� ... DATE 7..... Plans Checked By........ Date........ Approved By........ Date................. NOTE- When property validated this form constitutes a Building Permit. This permit expires and becomes null and void should work not be commenced within days from validation date, or should authorized construction be suspended or abandoned for a period of 120 days after work Is commenced. PERMIT INSTALLATION NO. EACH FEE Light Outlets..........._ Switches.._........ APPLICATION FOR 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............... Dryer........ Garb. Disp......... Dishwasher ............ ....... 2.00 .. ........... Water System (installation, Alt. or Repair) ................. 4.00............... MOTORS: 1 HP or less ........... ..............._.. _.... . . 2.00 Water Closet.... Water Fleeter.... 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 Sewer ......__._-----.......................................................... 8.00............... Time Clock ............................ ....... ......................... 1.60.­1.4.�i" Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00 .................... ............_ Bee Ord, current)...................*................................... Vacuum Breakers ............................................ ..............3.50.............. "se, �l occupancies Flat Rate1 L New T 1_15TMESIL Interceptor........ Water Softener.......: .............................4.00. ..'•. . Plumbing Piping without fixtures ....................... 4.00 D-800 sq. ft. $22.00 11501-1750 $34.50.............................. I........I.... "r......... 24.60 1751-.20000 37.50.............................. Permit Fee .......................................................................... 00 501-750 Misc. (See Ord. Current) ......................................... ..... 761-1000 26.00 2001-225C 39.50.............................. 1001-1250 28.60 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. 0)- 1261-1600 32.00 2501-2750 49.50.............................. APPLICATION FOR HEATING/COOLING PERMIr PermitFee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty it app.El) $7,,-b PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M ...............................$ 6.00.............. over 100M ................ ......... 10.00_ .00 ........... Comfort Cooling Unit.....to 3 ton/HP ......................... .. 6.00,.... ........... Forms / Foundation By:... . ....... . Date:................ to 15 ton/HP........................... 9.50............... Plumbing Ground Work ......... ...... ...... ... .......... . .... to 30 ton/HP............... ......... ..12.00. ............ Rough Electrical to 50 ton/HP................. ......... ..17.00.. ........... ne - Plumbing and Heating ....... Space Heater........ Wall Heater ................................. 6.00..7 .. ........... Gas Test ............. ........ ...... ... ........... .............. Flues - other than above ............................................ 3.00.. ........... Vent Fan: Kitchen........ Bath ....................... ............t.. 3.00............... ..................... Commercial Range Hood . ......I—....­�...... 0.. ...................... Permit Fee .............................................._....................... Final - Building/Mechanical ........... ... Final - Electrical ................__ _ ._. ................ ...... Misc. (See Ord. Current..................._....._............ Temporary Power Gas Elect. ........ ......................... Final - Design Review Landscaping ......... 6.00 leraulation & Energy....................�* * ................... TOTAL Htg./ Coo1g. Permit Fee (plus penalty if app. C]) III Final-Public Works ...........................................................