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1595 (2) 1,980 CITY OF CUPERTINO r; APPLICATION FOR RESIDENTIAL BUILDING PERMIT !' PERMIT NUMBER � S AND ' CERTIFICATE OF OCCUPANCY • R APPLICANT TO FILL IN BUILDING INSPECTION DIVISION S f��F7'_ADDACLMJr pR J CT . • • • • . Legal DDeescriipJtion:: Trac:..._. ....,... lock.......... Lot........ ..... Descrlp n of Work: .... .... ... �t.Gi....�haLU-4.�*....... Plans Received BY....................................................Date ........................ ............ ..... ....... - ............._......................._...........................__........................ REO.: Plena.... Survey.... Calca: Struc..... Energy.... Elect..... Mach.... let Str t. Improvement on Parcel:Yes.... No.... Area of Bldg............... Plans Checked By....................................................Date ......................... Separate Structure..... or Addition/Alteration to Exist. Bldg g........... Application Approved BY.........................................Date ......------............. No. of Stories................ Use of Building ................. ............................... Validated By............................................... ...... Date ........................ Valuation of Pr pct $ f Compensation Certificate Verified By .................. Date ......................... caner, .....L,�iG11.S..S ... 2G ... qGG'lY Phone:....... .. Contractor .(A.IIf1f9fY.15 ._._ .1• .Ovl'I-crelCity Bus. Lic. # ' • • " • $��k0 Contractor's Address: 4131..Mc_G IilY,C.�_Y. ..Ht4Phone:� �.-1.. Permit Fee (plus penalty f a licable Contractor - Electrical: ....._..............._.........._........................ .................. (P P Y i PP ) ........................$...a.T.....— Plan Check Fee (less deposit of $.......... Rct. #..........)$....................... Rye 'V City Business License #.........._......... Phone:.................... Energy Plan Check Fee (Dep. of $........ Rot. #........)$..................._.. Plumbing: ...._....._....................................................................... .. Strong Motion Fee ..........................................................$...........y.Z-0 City Business License #.................... Phone:.................... Heatingand Cooling .................................................................. Plumbing Permit Fee ................................................$....................... City Business License x................._.. Phone:.................... ElecVical Permit Fee ......................................................$............. ... ,Architect/Designer: ..._..._...._.........................._...... Phone:..,................ Mach. Htg./Coolg. Permit $............................. $.................... Engineer: Phone:.................... Residential Construction.Tax ..................._..........._......$_...../_.. .. .. .............._.........._.........._..................... DYT"" Lender: . ... ertify.that .......... .performance ...........................w c C] Unknown Misc. Fee .._.......... ................................... $......(p.............. "I candy that in the Performance of the work for which this Permit Is ' Issued i shall not employ any person in any manner so as to become subject • $_30, to the workman's compensation laws of California." SIGNATURE OF • • APPLICANT/OWNER ........... ............................_..._.._.................._ DATE........................ Environmental Status: Exempt ............ Other....................................... -1 certify that as the applicant I am licensed undo' the provisions of the Design Review Approval: Bldg. ...:....... Site ............ Sign ............ Contractors License o d 'that that my Loans, No. ............................ Use Zone ............ P.D. Conditions ........................ .... in Classification....... .g ......_. Is in full force and effect: or Cord. Use Permit #............ Variance If...... Parking Spaces............ . - I certify that I am exempt fro the "Licensed Required" provisions of the Approved By. Date Contractors License Law. (Stale basis of exemption.) """""""""""""""""". ....."""" """""""""'"""" I hereby acknowledge that I have read this application and stale that the above Is • • :orrect and agree to comply with all City Ordinances and State Laws regulating building. • CroBChmBnt Permit........................ Grant of Easement.-...... I (We) agree to save, Indemnify and keep harmless the City of Cupertino ....__....... against liabilities, judgments, costa and expenses which may in any way iGutter, Sidewalk, Driveway: Replace.......... Repair........., secure against said City In consequence of the granting of this ran It lower f COM. Fee $.........ubli....... Water..........rov Meter .................. SIGNATURF. OF (\ jls8L �����.1 Agreement for Completion Of PUbIIC Works ImprOVBRIB013 .................. APPLICANT/CONTRACTOR ./I/—.EIfIy . ........_ DATE .�.... .Cd.0 Plans Checked By........ Date........ Approved By........ Date.................... NOTE: When properly valid le this form con as A Building rml1. 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 eller 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) ............ $ ,5o ............ 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............... —200amp......... 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. it. $22.00 1501-1780 $34.50.............................. MISC. (See Ord. Current) .......... 501-750 24.50 1751-20000 37.60.............................. ................................6.00 .... 75f-1000 26.00 2001-2260 39.50.............................. Permit Fee ........................... ( ................lty I....................$8.00 1001-1260 26.60 2261-2500 42.00............ TOTAL PLUMBING PERMIT FEE (plus penalty If app. [J) § 1251-1500 32.00 2501-2750 49.50.............................. . • • •• •e LING PERMIT Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.0) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M ..............................$ 6.00............... — • RECORD over 100M ....................... . 10.00.........I.... Comfort Cooling Unit......to 3 ton/HP ........................... 8.00... ........... Forms / Foundation .............:. .............. BY:........ . ..... . Date:. .............. to 15 ton/HP................ ........ 9.50.............. Plumbing Ground Work ...................... ..... . .............. ........................... 10 30 ton/HP............................12.00.............. .Rough Electrical .................................... .. .. ......... . �f p to 50 ton/HP...........................17.00.. ........... ems - Pfrwtbir+SaM+leetirl. ........ . .. ......_.....X1-17.'9!2 8 00 ulation 8 Ener Space Heater...... han Wall Heater ................................... .. ........... 9Y............................... ........ .............. ........................... Flues - other than above ...................... .......... 3.00.............. s Test ............. .... ................... .. . ..... .................. ........................... Vent Fan: Kitchen........ Bath .......................................1f`.. 3.00............... am, m PorarPower Gas / Elect. ........ .................................................... Commercial Range Hood ... . ........................... J 8.00............... Forel - Electrical ... i .. ......._.......... ..._...._................ ....... ..........:........_...... fMlsc. (See Ord. Curren[............. ................................................$ 6..,...... Final - Building/ Mechanical .................................................................. Permit Fee ........................................................................ $ 8.00 Final - Design Review / Landscaping . ......................................... . TOTAL Htg./ Co Ig. Permit Fee (plus penalty if app. ❑) $ Flnel-Public Work ......................... .. . ;