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2112 (2) CITY OF, CUPERTINO N . CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMITAPft J PERMIT NUMBER ;2/ Z AND FOR APPLICANT TO FILL IN CERTIFICATE AND OCCUPANCY BUILDING INSPECTION DIVISION STREF� gFiESS,OF��P iQQECT: ^ - - • . • • Legal Description: Tract....�.0......-.1....`....t....Blocker"......,-._Lot...................... Description of Work: .S_,24,a. .....�.....W..Cn�:S^........._................ PiensReceived BY........................_...................__...Date .............. _ ............._....._......__._............................................_.._..._.........._............. .. ........... REO.: Plans.... Survey.... Cal s: truc..... Energy.... Elect.... M h.... 1st St rucI. Improvement on Parcel: Yes.... No...Area of Bldg............... Plans Checked By.............. .... ..................__.....Date . Separate Structure............ or Addition/Alteration to Exist. Bldg 9........... Application A roved B .. ............................Date .. ....... PP PP Y � - �� ��� No. of Stories................ Use of Building .................. ............................... Validated BY.._................. _........................._.._.....Date ...................... -Valuation of Pr ii: $ _ .. . ......../J. ..h . . .. Compensation Certificate Verified By ................. Date ......................... Owner: . .GL. t Phone' Contractor: ..... ........ ............. .........................City Bus. Lia k ........ • • • • • $ Contractor's Address: ...................................... ..... Phone:.................... Permit Fee (Plus penalty if applicable) ........................$.._................... Contractor - Electrical: ..,....._.................................................................... Plan Check Fee (less deposit of$..—..... Rct. #.... .....)$_................_... City Business License +k....____...... Phone:.................... Energy Plan Check Fee (Dep. of $........ Rct. #........)S_ Plumbing: ...................................................................................... Strong Motion Fee .............:................... ........... ............$........ .... ..:._.. City Business License A........._........- Phone:.................... rJ Heating and Cooling ..........__.................................................... Plumbing Permit Fee ................................................$...A-r. ----..... Electrical Permit Fee _._.............._...................._..........$..._........._...... City Business License ....... _.- Phone:.................... Mach. Htg./Coolg. Permit $............................. $------------...._.... Architect: Designer: ............._................................ Phone:.................... Residential Construction Tax ..... ..................................$_..................... Engineer: . . . .._......._..........._._...-............_............ Phone:...............wn _.... Lender: .. tify t. ......._... per _mane...... the................w .. ❑ Unknown Misc. Fee ...._.................................._...._......-.................$._............- •I certify that in the performance of the work for which this Parmll Is Mise. Fee ...._............__..._........... ......................_.........$.............. ........ issued shall not employ any person in an manner so as to become subject pp Y l� �/ e : $ to the workmanjs co saws of Oat Drilla." L ATE/ / t.+./ SIGNATURE OF !6.... l/.-D �'� • • APPLICANT/OWNER .. .. ... ..... Environmental Status: Exempt ............ Other........... ................ .... "I certify that as the applicant I an licensed undethe 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 lull force and effect: or Cond. Use Permit a..... ' Variance •....... Parking SpacesI cerufy that I am exempt from the "Licensed Required" provisions of the - -"" ....... .........._ Contractors License Law. (Stale basis of exemption.) Approved By.......... ....................................... 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. 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 lib, Gutter, Sidewalk, Driveway: Replace_........ Repair...._.... acture against said City in consequence of the granting of this permit." Sewer............ Conn. Fee $................ Water................ Meter $................ SIGNATURF OF Agreement for Completion of Public Works Improvements .................. APPLICANT/CONTRACTOR .......... ............................................. DATE .......-............ .. Plans Checked By........ Date........ Approved By........ Date.................... NOTE: When properly validated this farm constitutes a Building Permit. This permit expires and becomes null and Vold should work not be commented within • 120 days from validation dale, or should authorized construction be suspended or abandoned for a period of 120 days alter work is commenced. PERMIT INSTALLATION NO. EACH FEE Light Outlets...._. Switches............ APPLICATION 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) ..........ir-_. 4.00,3X... MOTORS: 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............... mp Temporary Power Pole or Service — 100 a . ....... . 5.00 .............. Wash. Mach..... Dishwasher.... Garb. Disp..... ............... 3.00............ —200 amp...._.. . 7.00 .............. Sewer ..............__._.................................................1...... 8.00.X.Y . ISI 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.............................. Misc. (See Ord. Current) .......... 501-750 24.60 1751-20000 37.50.............................. ..............................$6 00 .... 751-1000 26.00 2001-225C 39.50.............................. Permit Fee ..-...................-.... ( ..............alty......................11/f. 1001-1250 28.60 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. [j) $ �80jj 1251-1500 32.00 2501-2750 49.50.............................. APPLICATION FOR HEATING/COOLING PERMIT PermitFee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if apP•0) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit._...............to 100M ...... ........................$ 6.00... ............ INSPECTION RECORD over 100M ........................ . 10.00.. ........... Comfort Cooling Unit.....to 3 ton/HP ................. ........ .. 6.00............... Forms / Foundation .........00. ... ...... _LL. . xx .. . .-may Dat ../... to 15 ton/HP................._...... 9.50............ ,. Plumbing Ground Work .¢�J:d11.F. �.W.t...../,¢.. __.$ /6 .8I to 30 ton/HP........................... 12.00. ............ Rough Electrical ............-............._.._...J.. ._...._........... ......._........_....... to 50 ton/HP.......................... ..17.00.............. as - Plumbing and Heating ..........I......................... ........................... Space Heater........ Wall Heater ............-.................... 6.00 _ ............ laden 8 Energy.............................. .................................................... Flues - other than above ............................................... 3.00... ............ as Test .................................. ... .. ........ . ............... .... Vent Fan: Kitchen........ Bath ......................................... 3.00............... Temporary Power Gas / Elect. ...............-....._........L......._................. Commercial Range Hood 6.00_....,,,,,,,, Final - Electrical ............_................. . ...._........_.........(`..__.................... Misc. (See Ord. Current........._............._..............�..........._......... Final - Building / Mechanical ......___........................._I - . Permit Fee ............. $ 6.00 ................. ....................................... Final - Design Review / Landscaping . ... .......... ..... ................... . TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. ❑) $ Final-Public Works ...........................................................