The URL can be used to link to this page

2033 (2) • CITY OF CUPERTINO CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT MAR ) PERMIT NUMBER 1 CERTIFICATE OF OCCI . . FOR APPLICANT TO FILL IN UPANCY BUILDING INSPECTION DIVISION F1pDOF` EC�T:� • • . - • Lega Description: Tract........................ Block............ Lot...................... Description of Work: ...f 0bZ)/.7/O/V................-............................ Plans Received By....................................................Date ...... RED.: Plans.... Survey.... Calcs: Struc..-_ Energy.... Elect..... Mecp.... tat Strict. Improvement on Parcel: Yes.... No... Area of Bldg....._........ Plans Checked By................ .. Date ..... p�. Separate Structure............ or Addition/Alteration to Exist. Bldg........... Application Approved By..... Date Ile No. of Stories................ Use �Building .................. .................. .o..... .......................... Validated BY.................................-...........................Date ........................ ValuationP of t: ,,gg. t„cU,r ..............................,�....n..``...:........ Compensation Certificate Verified By .............._. Date ...................._. Owner: DL ,.Y._.... _.. ..,,,,...._._.,,,_.__.,....,,,. PhoneJ. r..............� $� Contractor: ........ _......__........._...................._.City Bus:Lic. # ,,............ 5} D0 • • • • s Contractor's Address: ..._......._..................................Phone:.................:.. Permit Fee (plus penalty If applicable) Contractor - Electrical: .. ......... ....... .................. ....................... Plan Check Fee (less deposit of$.......... Rct. #-.........)$........ .............. City Business License #........._ ........ Phone:..... .......... Energy Plan Check Fee (Dep. of $........ Rct. #........) $........ .:.... . Plumbing: Strong Motion Fee .......................... �,.. City Business License #..........-......... Phone:.................... ................. ��""�"�$��"'�� Heating and Cooling ......... Plumbing Permit Fee ...... ..................................$"" City Business License #.......--........ Phone:................... ....... ....... Electrical Permit Fee ......--...................--................. Architect/Designer: . Mach. Htg./Coolg. Permit $............................. $..................� .................. ............'................. Phone:.................... ... Engineer: ...................... Phone:.................. . Residential Construction Tax ...._......................-........-$....................... ........... .................._.-Lender: which ❑ Unknown ... ... "I certify that in the performance person of the work for which this permit is Misc. Fee ....._...._._........._..................._.........._......../$.......4......w_......\ Issuetl I shall not employ any person in any manner so as to become sublet[ • . , . : o $ 3 a d d 1 to the workman's omp ation ws of.VECorple." J SIGNATURE OF �i (/j{�-{/.P_ ZONING REQUIREMENTS APPLICANT/OWNE�.. .. _....C..............._.................. DATE......................... Environmental Status: Exempt __........ Other..........-............................ "1 certifythe s the applicant I am licensed undo' the provisions of the Design Review Approval: Bldg. .........._ Site ............ Sign _.......... Contractors cense Law and further that my Licens. No. ..............._.......... Use Zona P.D. Conditions ............ Cond. Use Permit #.........._ Variance #............ Parking Spaces... I certify 1 1 I am exempt from the "Licensed Required" provisions of the Approved B Date Contractors License Law. (State basis of exemption.) r pp Y --- ---------- - """'- I hereby acknowledge that I have read this application and state that the above is _ errnct and agree to comply with all City Ordinances and State Laws regulating • - • buildwq. - 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 b, Gutter, Sidewalk, Driveway: Replace.......... Repair...._ ... occurs against said City in Consequence of the granting of this permit.'' er............ Conn. Fee $............-- Water................ Meter $..........:-... SIGNATURE OF reement for Completion of Public Works Improvements ..........._.... APPUCA NV CONTRACTOR .......................................................... DATE .......... ............ Plans Checked By........ Date........ Approved By....... Date.................... NOTE: When properly validated this form constitutes a Building Permit. This permit expires and becomes null and void should work not.be commenced within • , . 120 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 APPLICATION ,• - - Light Outlets...I..... Switches.J........ Fixtures.........:.. Receptacles...... G B� 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............... Sewer ............................................................................... 8.00............... Time Clock ...........--.............................-................ ...... . 1.50............... Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00..................... ...........-. Misc (see Ord current l:.. .. .... ..... .................................. 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.............................. Misc- (See Ord. Current) ................................ .................... 501-750 24.50 1751-20000 37.50.............................. Permit Fee ...................--..........-.....................................$6.00 751-1000 26.00 2001-225C 39.50.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. ]) $ 1001-1250 28.50 2251-2500 42.00.............................. 1251-1500 32.00 2501-2750 49.50........................ ..... • • • • • - PermitFee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.[]) SA.n PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M ....................-........$ 6.00..:............ INSPECTIONRECORDover 100M .......................... 10.00.............. _ Comfort Cooling Unit_ /HP....to 3 ton/HP ................. ....�.. 6.00,.............. Forms / Foundation ....._...................... I By:... . .,.._. . Date:.. � to 15 torl......................... 9.50.............. Plumbing Ground Work ..........-......... I..... .... to 30 ton/HP...........................12.00. ............ Rough Electrical .#.. ✓av»w........ .... to 50 ton/HP.........................'..17.00.. ........... a((nne - Plumbing and Heating ..........I Space Heater........ Wall Heater ...................-.............. 6.00,.-........... r0lation 8Energy............................... G Flues -other than above .............................................1 3.00.............. ............-.......-�..i..."'._........_........ `.. - s. Test ............-............................. ......................... ........................... Vent Fan: Kitchen........ Bath ..................--......-1-....... 3.00............... mporary.Power Gas / Elect, ........__.................. Commercial Range Hood 6.00„_,__..... . g ................................... ....... .. .. Nnal - Electrical ..........._............._._..............................t........ Misc. (See Ord. Current..................._....._........-................... Final - Building / Mechanical ..._..................................L......... ............... Permit Fee .................._-.......... . .. $ 6.00 Final - Design Review / Landscapin i ... � 'r 9 9 �-��--�---�---�-�-��--�� TOTAL Htg./ Coolg. Permit Fee (Plus•penalty I aPP• O) $ inI- Public Wor . ......................................................... W �IO/8/ .