1144 (2) CITY OF CUPERTINO
APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER
AND • ,
APPLICANT TO FILL IN& CERTIFICATE OF OCCUPANCY
BUILDING INSPECTION DIVISIONSTRE T ADDRESS QF�PROJ ECT:
• • • • IIIIIIIII meLegal Description: Tract.. Block
.. ._...... Lot_...._..............
Description of Work: _. ��N-1�.,.e -
PlansReceived By._....._.................... Date ...-_................. ._...._.........................._........._. ..
._...._..... t I. ......._.._a..............._............
REQ.: Plans.... Survey.... Calcs: Strut..... Energy.... Elect..... Meeh.... 1st Strutt. Improvement on Parcel: Yes.... o... Area of Bldg...............
Plans Checked By........................ . . Date ... .. .. Separate Structure............ or Addition/Alteration to Exist. Bldg...........
Application Approved By........... ..t_Lx........_.....Date ....... No. of Stories............._. Use of Building
Validated B .................. .._..._._.....:....._......
By .... Date ..-.... .... Valuation of Protect: $. . ........
Compensation Certificate Verified By . ... Date .. "'
..--...- Owner: 6AR444 ..Kax.f.cQa� ... _.. Phone.'t.5.rr.. (/34
• • • • • ContractBr: •?on,.J,lea -J.(/or7t' City Bus Llc k 1613
$ Contractor's Address: 1A1- 3 .. �°`"'�.. Phone:9.-8ii
Permit Fee (Plus penalty if applicable) -........ _ ........... ..... Contractor - Electrical: ......--............_..... _ ....................... . .......
City Business License #..._............_ Phone:...........'..-......
Plan Check Fee (less deposit of$.......... Rct.#.(.'-....)$........... ...._..... ,
Energy Plan Check Fee (Dep.`of $........ Rct. #........)$.........._..... ..... Plumbing: ......_....... ....----.....__..._................... ........... ...
Strong Motion Fee .......................�..`.t.....=!..� :.._�....._$.........-__......... City Business License #................._. Phone:_......._.._.....
r....J Heating and Cooling ................_..........-............_.........._........
Plumbing Permit Fee ................................................$................------.
Electrical Permit Fee .._.............n..._A--.......-.... City Business License #.{4-13.¢... Phone::15-14 x.4.31
Mach. Htg./Coolg. Permit $........:..�....I..jl?a. ... $.�.a2a:.057... Architect/Designer: ............................_.___......._.._ Phone:....................
Engineer: . . .. .......... .... .......... .................--... Phone:._.._.............
Residential Construction Tax ...................._.........._'.....$.................--... Lender: . Unknown
Mise. Fee ........__....-................................_.............._....
Misc. Fee it certify l in the performance of the work for which this permit Is
issuetl shall not employ any person f any manner so as to become subject
• $ to the workman's compensation laws of California."
SIGNATURE OF
ZONING • - APPLICANT/OWNER .__..........._..................._-............................. DATE........................
Environmental Status: Exempt.......... Other.....-..... .... ....... .. ..... .I certify 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 certify 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
• - • correct and agree to comply with all City Ordinances and State Laws regulating
building.
c I We) agree to save, indemnify and keep harmless the City of Cupertino
croachment Permit-..................... Grant of Easement.............._....... against liabilities, judgments, costs and expenses which may in any way
u rb, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... acture 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 ...----....... APPL ICA NTi CONTRACTOR��G//..L c!.•v...:........... DATE
-///-00
Plans Checked By........ Date........ Approved By...._.. Date._...._....._.... NOTE: when properly validated this form constitutes a Building Poll This
permit expires and becomes null and void should work not,be commenced within
APPLICATION • 120 days from validation date, or should authorized construdlon be suspended or
abandoned for a period of 120 days after work is commenced.
PERMIT INSTALLATION NO. EACH FEE
• • •
Light Outlets............ Switches.......--
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 ...-.-........................._.......... .. 1.011...............
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._................ .- 4.00 ...........
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 .................. .......-........._...._-............... ......... 1.50... ............ Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00..................... .............
Misc. (see Ord. current)...................................................... Vacuum Breakers ...._.................._............. .... ..............3.50..............
New Residential Occupancies Flat Rate Interceptor........ Water Softener..__.. ................ ...._......4.00. ............
Plumbing Piping without fixtures ....................... ............4.00,,,,_._„__,..,
0-500 sq. ft. $22.00 1501-1750 $34.50.............................. Mise. (See Ord. Current) ..........
501-750 24.50 1751-20000 37.50.............................. .................................... .
751-1000 26.00 2001-225C 39.50.............. Permit Fee ..-..................................-...................................$ 6.00
1001-1250 28.50 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. C)) $
1251-1500 32.00 2501-2750 49.50..............................
Permit Fee...............................................$6.00 i APPLICATION FOR HCATINGICOOLING PER.MIT
TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app•O) $ PERMIT INSTALLATION NO. EACH FEE
Forced Air Unit....._..._......to IOOM ....._............. ... 6.00-. -0
' • - ' over 100M ......__...__......... 10.00..............
Comfort Cooling Unit......to 3 ton/HP .............._........... 6.00... ._........
Forms / Foundation .. ......_._........._.... By:._..... ....... . Date:...._......_.. to 151on/HP................. ........ 9,50..............
Plumbing Ground Work ................ ..._....._...............
ugh Electrical to 30 ton/HP......._...._......_....12.00. ............
................._._.........._.. ._..................._. .......__._._.__..... to 50 ton/HP.-....._............... ..
17.00.. ...........
Wme - Plumbing and Heating .......... ..............._........ ........_................. Space Heater........ Wall Heater ...._......................._... 6.00.............
to talion 8 Energy........._._..........__... .....................__.._....................... Flues - other than above ............. ._._..�. 3.00..._.........
as Test ......._............_............_... ... ........_............_.'.............._........_. Vent Fan: Kitchen....._. Bath ..............._.............. ........ .. 3.00,..
............
Temporary Power Gas / Elect. . ................................. ......................... . Commercial Range Hood _ 6.00
Final - Electrical .................................... 9 ....................-.......... .. ........
..........._._......... ........._....._...._... Misc. See Ord. Current..
Mec
Final - Building /Review
/ Lan ...apin............................. ._..._................... Permit Fee ...............--....._....._. 6.00
Final - Design Review Landscaping . ...... ........................................... TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. ❑) $ 1 a,aa
Final-Public Works ...........................................................