The URL can be used to link to this page

1474 (2) CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT ;j L;li i PERMIT NUMBER 7;,�7 AND • APPLICANT TO FILL IN - i, CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION IST DD SS OF ROJ CT' NL 1 �..0.`I ......d'PrbF-s L.................................................... • • • • Legal Description: Tra .............. lock............ Lot. .... .............. Des 'ption of Work: .. =03C..';Au .............. Plans Received B . . ............Date .1q._//3.. Q Q.Q.4.._............ . REQ.: Plans.... Survey.... alts: Strut..... FOergy.... Elect..... Mach.... 1st Struct. Improvement on Parcel: Yes.... No... Area of Bldg............... Plans Checked By....................... ... ,(/ Dete ..... II .. Separate Structure............ or Addition/Alteration to Exist. Bldg........... Application A roved B -.. . �[. Date . .. ..l�. No. of Stories................ U e of Building Validated By............................ ....... Date ......__._..___... Valuation of rolpct: $>A�:3.raQ. ... .._.____............... Compensation Certificate Verified By ............_... Date ................. ..- Or.'777R•$.....?446Y"1.IQS......... Phone:..../ Contractor: .q. 5oi_./t-2. ..... City Bus. Lic. # • • • $ 3, 5-a a Contractor's Address: UHtBf4fQ /l.gp1icPhone: ... Contractor - Electrical: . '^' Permit Fee jus penalty f a licable 99 - -��-��'��`��.....-."' IP P Y i t o ) ..Rct..#...........$c�. .._..7FJ... City Business License #.................... Phone:.................... Plan Check Fee (less deposit . f $....... Rct. #..........)$.......`J.......... Plumbing: ...................................................................................... Energy Plan Check Fee (Dep. of $.....-.. Rct. #........) $....................... $..........-_ 'U.. City Business License #.................... Phone:.................... Strong Motion Fee ......._..:......__.._..._........:.............._. Heating and Cooling ............. Plumbing Permit Fee ._. . - . $ ...D,......._ ......................._..... :..............._-.. - -�� --"� ��"' �'�"'V. --� City B 'ness License ........ Phone:. .. Electrical Permit Fee ......................................................$.......7e.5........ y�y p Mach. Htg./Coolg• Permit $............................. S........._......--... Architect: Designer: rP�:��... ...... ..�... Phonea.g.....'R... Residential Construction Tax ........................................$...............-....... Engineer: ... . ............................................................. Phone:...............wn Lender: ... .... ...... _._...... _.................................._....... ❑ Unknown Misc. Fee .................. ...._...___................... .......... ...... ..�..........._....... "I tautly that in the Performance of the work for which this Permit Is Misc. Fee ........................................................................$................. issued I shall not employ any person in any manner so as to become subject $ 0 r ('/TJ to the workman's compensation laws of California." SIGNATURE OF • MTOWN117=11IIIIIIIIIIII APPLICANT/OWNER ....................................................................... DATE........................ Environmental Status: Exempt ..... Other....................................... .�,. 'I certify that as the applicant I am licensed unde the pCpvisiggpp of e. Design Review Approval: Bldg. ............ Site ............ Sign ....__-... Contractors License Law and further that my Licens. No. Z.Y.. .y.. Use Zone P.D. Conditions in Classification .........C—MS'.3........... 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 Date Contractors License Law. (State basis of exemption. PP Y........................................................... ..._...................._ I hereby acknowledge that I have read This application and stele that the above Is :orrect and agree to comply with all City Ordinances and state Laws regulating • • buildmg. 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 urb, Gutter, Sidewalk, Driveway: Replace.......... Repair ... acture against said City in c nsequenc f the granting of this permit." Sewer............ Conn. Fee $................ Water......._....... Meter $........ _... SIGNATURE OF rr Agreement for Completion OF PUbIIC Works Improvements ..._............. APPLICANT/CONTRACTOR .. . ...... DATE/�_��1.3.�6 Plans Checked By........ Date........ Approved By........ Date........__........ NOTE: when properly validated this form consul as a Building Permit. This permit expires and becomes null and void should work not be commenced within 110 days from validation date, or should authorized construction be suspended or abandoned for a period of 110 days after work is commenced. PERMIT INSTALLATION NO. EACH FEE APPLICATION FOR 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..................... 4.00. ............. 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... ......... L Sewer ..................................................................... ........ .. 8.00............... Time Clock .................................... ................................... 1.50...../s Lawn sprinkler Sys. $5.00 Ea. add Sys. $2.00..................... ............. Misc (see Ord. current 1.... ..... ........................................... Vacuum Breakers ............................................ ..............3.50.............. New Residential Occupancies Flat Rate Interceptor........ Water Softener........ .............................4.00. ........ Plumbing Piping without fixtures ...................................4.00. .�,GD?t- 0-600 sq. ft. $22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) .......... .......................................... 501-750 24.60 1751-20000 37.50.............................. Permit Fee ..........................................................................$ 6.00 751-1000 26.00 2001-2250 39.50.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app.Q) a r!+ 1001-1250 28.60 2251-2500 42.00.............................. 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 NO. EACH FEE 7 � Forced Air Unit..................to 100M ..............................$ 6.00............... INSPECTION RECORD over 100M ........................ . 10.00.............. Comfort Cooling Unit......to 3 ton/HP ......................... .. 6.00............... Forms / Foundation ............... ...... ..... . By:........ . ..... Date:................ to 15 ton/HP......................... 9.50.............. Plumbing Ground Work . .................... j.... ................._......................... to 30 toll................. .......... 12.00. ............ Rough Electrical ..........._........... to 50 ton/HP......................... ..17.00.............. -'nme - Plumbing and Heating ................................... ........................... Space Heater........ Wall Heater ........................... ....... 6.00.............. ulation & Energy............................... ......................... ........................... Flues - other than above ..................................... ........�-. 3.00.............. asTest ..............................._.. _... .. .... ...... ........................,_..___.. Vent Fan: Kitchen........ Bath ....................................... .. 3.00............... Temporary Power Gas / Elect. .__... ......................... ..........._._.__-- Commercial Range Hood 8.00._____....... Final - Electrical .................. 9 .......................................... .. _.........._._ ......................... ......................_... Misc. (See Ord. Current_.. .......... Final - Building/ Mechanical ........_.... ........._......................._.............. Permit Fee .......... Final 6.00... Final - Design Review / Landscaping . ... ....................._.........____ TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. ❑) $ Final-Public Works ...........................................................