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2067 (2) cur ur ;.,urt:hulvU -� h tsar 'e CITY OF CUPERTINO PAID I APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER ad( AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STREET ADDRESS OF PROJECT: ...............7 s'33...... ................. • • • • • Legal Description: Tract........ :.. .......... Block.. ........ Lot...................... Plans ReceivedDescription of work: ._.._...�o-jT_..../k.V.!. ........... ... .. 7•E:�......n�4L.!9�.............. y....................................................Date ......................... .......__._ ._....._-..__.........................._........... REQ.: Plans.:.. Survey.... Cads: Strut..... Energy.... Elect.....,,,MMM8 h.... 1st Struct. Improvement on Parcel:Yes.... No.... Area of Bldg............... Plans Checked By.............. .. . ..........................Date ...,../J.. _ Separate Structure............ or Addition/Alteration to Exist. Bldg........... Application Approved By... . .. Date .../. No. of Stories................ Use of Building ........._.....................:.................. ........................... Validated By..................... ......................................Date ............:.......... Valuation of Project: $....310lib............................ .................................. Compensation Certificate Verified By -..........-... Date ......................... Owner: .......... ...... .................... Phone:.................... Contractor: ...lYds. o^..�...T�..�'.u...'�.....City Bus. Lic. +r ..... ....... • • • • • $�� � Contractor's Address: . 34�G'.„SS�.StfGo r Ph one 322:7 'O Permit Fee (plus penaltyf applicable') 4 J-D Contractor - Electrical: ... Plan Check Fee (less deposit of$.......... Rct. #..........I$.._......__...._.. City Business License #..._............... Phone:.................... Energy Plan Check Fee (Dep. of $........ Rct. #.._...-) $.._......_... Plumbing: ................_-..........................:...................._.................. -'tj" _ . Strong Motion Fee ..........................................................$........i S. . . City Business License 0.............__.. Phone:........ ........... Plumbing Permit Fee Heating and Cess Li ..._...................................._..._.......... :.................... City Business License .................... Phone:.................... Electrical PermitFee ......................................................$..� .. ......... Architect/Designer: .................................................. Phone:.............._..... Mech. Htg./Coolg. Permit $............................. $....-................. ResidentialConstruction Tax .._...................._..............$__...... Engineer: ....._...._.......... ................_.........._.............. Phone:...............wn .. or w c ❑ Unknown Misc. Fee $....................... ................................................... Len er certify that in the peany perso of the work for which this permit Is Misc. Fee ......... ......... ......... ......-$...jj.// ...,t._.� � � issued I shall not employ any parson in any manner so as to become subject • $ VJ (O r U v to the workman's compensation laws of California." SIGNATURE OF • • - 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.IyL,ttor that my Licons, No. .................... ... .J Z. _r '.7d' ... . Use Zone .._........ P.D. Conditions ,,n ............ m Classification . ...... is in lull force and el/act: Or ....................................... Cond. Use Permit #_......... Variance #,,.......... 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 Cr08chment Permit........................ Grant of Easement................r....... against liabilities, judgments, costs and expense toh may in any Way ,.urb, Gutter, Sidewalk, Driveway: . ' Replace......_. Repair.......... acture against said City in conse f t ming of this per Sewer............ Conn. Fee $................ Water................ Meter $................ SIGNATURE OF Agreement for Completion of Public Works Improvements ... ...... APPLICANT/ ONTRAcrOR ....... DATE............. DATEiT_S . 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 APPLICATION • 170 days from validation date, or should authorized construction be suspended or abandoned for a period of 170 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) ............ $ Y000 Gas System with up to 5 Outlets .................................$4,00 .......Range........ Cooking Unit........ Oven............ ......... ....... 2 ...- Each additional outlet ............................................. 1.00............... Dryer........ Garb. Disp......... Dishwasher ...... ... ...... 2 . ........ Water System (Installation, Alt. or Repair) ................. 4.00 ,,,. .MOTORS: 1 HP or less ................................................. . 2 �oZ-.Ca) Water Closet.... Water Heater_( Ld. Tray................... .. 4.00. �_Greater than 1 HP not more than 5 HP .........._ . 3 ..........- Lavatory.... Shower Pan.... Bathtub.... Sink................... 3.00...............Temporary Power Pole or Service — 100 amp . ....... ..5f...........: 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 1 ... ................................................. Vacuum Breakers ............................................ ..............3.50.. ............ New Residential Occupancies Flet 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 24.60 1751-20000 37.50............ • . .••.•..-. ..•.••. .................. Permit Fee .............................................................$0.00 751-1000 26.00 2001-2250 39.50.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. []) $ dti 1001-1250 26.50 2251-2500 42.00.............................. r 1251-1500 32.00 2501-2750 49.50.............................. APPLICATION FOR HEATING/COOLING PERMIT Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.p) $�,?U� PERMIT INSTALLATION NO. EACH FEE Forced Air Unit......-..........to 100M -............................$6.00............... INSPECTIONRECORD over 100M ................. ....... . 10.00.............. Comfort Cooling Unit......to 3 ton/HP ........................... 6.00............... to Forms / Foundation .... ......................... By...._.........._.. Date: ..............._ 15 ton/HP................. 9.50_............ 9 ...... Plumbing Ground Work . .._.............._ 1. .. ............._...._.. P 30 ton/HP............................ 12.00.............. _Roti h Electrical ....................... ............ 50 ton/HP............................17.00.............. me - Plumbing and Heating ...... ...................... Space Heater........ Wall Heater 6,00 ;ulatlon & Energy ... .. ._... Flues - other than above .:.. 3.00 'as Test ......... .. .. .... ... ....h'.. ........... Vent Fan. Kitchen........ Bath ..................................... 3.00 ...... Temporary Power Gas / Elect. . ........ .........................I..................... ... 6.00......'...... Commercial Range Hood .......................................... .. ........ Final - Electrical ....................... ..... .. _. .._.. . ........... ._... Mise. (See Ord. Current........................................�....................... ... Final - Building F10fEClffinf•cal . ... .._._ .... ........_ _.. ......... ....._ Permit Fee $ 6.00 Final - Design Review / Landscaping ..... ................L..............__....... TOTAL Htg./ Cool9 Permit Fee (plus penalty if app. E]) $ Final-Public Works .....................................