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1182 (2) CITY OF CUPERTINO - APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER AND • . CERTIFICATE OF OCCUPANCY APPLICANT TO FILL IN BUILDING INSPECTION DIVISION STREET 2rQ p MESSOrCT�-Oe 5,*. r • Legal Description: Tract....{./g]....... ...... vBlock............ Lot...................... Description of Work: .... I. .1.............................. Plana Received BY....................................................Date ......................... RED.: Plans.... Survey.... Calcs: Struc.. Energy.... Elect.... Me h.... tat Struct. Improvement on Parcel: Yes.... No... Area of Bldg............... Plana Checked By............... .... .. Date ^ Separate Structure............ or Addition/Alteration to Exist. Bldg........... Application Approved By...... .. Date .. . 21..... No. of Stories. Use of Buildjn a.�._.. ............. / ............................ ... Validated By..................................................----.......Date ........................ Valuation of Project: $..... /......... ....._......_.. Compensation Certificate Verified By ................. Date ............,.�.... Owner: . ..•�B �< y �e/':h::::::::: Phono:y'g:G:ll ��CC'' Contractor: q,C. _..fBtL'QAs!L#... Citt Bus. Lic. # «A.O..eo • ' • $ Contractor's Add a: .13dHWW . k/, Phone:2fi'7.�rJ'Y cr�si9r. Permit Fee jus snail f applicable) T� Contractor - Electrical: ............................................ ................................. lP penalty i PP ) ..Rct................$.... .... .. .. ..... Plan Check Fee (less deposit of$.......... Act. #..........)$........ � City Business License #.................... Phone:.................... .. ...'... Plumbing:Energy Plan Check Fee (Dep. of $........ Rct. #........)$.................. City Business License #.................... Phone:.................... Strong Motion Fee ......................... $.............>5�.. CITY vF'LL��':R'.'O""" Heating and Cooling ......_._........................................._............ Plumbing Permit Fee ................................................$....................... City Business License #............_....... Phone:.................... Electrical Permit Fee ................................ .......It1�41'I...$...._................. Architect/Designer: .........................._........._._...... Phone:.................... Mach. Hig./Coolg. Permit $.....���)��.�... .......... $.._.................. Engineer: ...._ ........................_.................................. Phone:.................... Residential Construction Tax ........................................$......... ... . Lender: . .. .............. Unknown 0-d .. .... ...................... .. Mise. Fee .......................................... ...... .....y.....('� $.......�a...... "I certify that in the performance of the work for which this permit Is MISC. F88 ................................_....._ .............E_....A R._.$.......'./......_..... issued 1 shall not employ any person in any manner so as to become subject • $ p�•y—,yS� to the workman's compensation laws of California." SIGNATURE OF EFT-Tiff • 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 further that my Licens. No. ............................ Use Zone P.D. Conditions ...._._ in Classification .......... ................... 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 pp y._._..............................._................... Date ............... ..... Contractors License Law. (State basis of exemption.)I hereby acknowledge that I have read this application and stale 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, costa and expenses which may in any wa rb, Gutter, Sidewalk, Driveway: Replace.-__... Repair.......... occurs against said City In consequ)nff��of the granting of this permit."Y 4wer........... Conn. F80 s..............ubli. Works.......rev Meier .........._.._.. SIGNATURE OF � /_'/ AgfeBnlBDi for DOmpIBIIOn Of PUbIIC Works Improvements .................. APPLICANT/CON TgACTOR r>'�/�{L' .,Q ...,. DATE C..: .p.'...�..".� Plans Checked By........ Date........ Approved By........ Date.................... NOTE: when properly dated this form constitutes a Building Permit. This permit expires and becomes null and void should work not be commenced within APPLICATION • 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 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............... Sewer ............................................................................... 8.00.. ............. Time Clock ..................:................................................... 1.50............... Lawn Sprinkler Sys. $5.00 Ea. add sys. $2.00..................... ............. Misc. 1 see Ord. current 1.... ................................................. Vacuum Breakers ............................................ ..............3.50.. ............ New Residential Occupancies Flet Rate Interceptor........ Water Softener........ .............................4.00. ............ 0-500 sq. ft. $22.00 1501-1750 $34.50.............................. Plumbing Piping without fixtures ...................................4.00_ ............. Misc. (See Ord. Current) .................................................... 501-750 24.50 1751-20000 37.50.............................. Permit Fee .................................. .. 751-1000 26.00 2001-2250 39.50.............................. E (plu .......alty......................$ 8.00 1001-1250 28.60 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty If app. [�) _ 1251-1500 32.00 2501-2750 49.50.............................. APPLICATION F• . HEATING/COOLING PermitFee...............................................$B.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.p) $ PERMIT INSTALLATION 11NO.1 EACH I FEE �_ Forced Air Unit..................to 100M ..............................$6.00............... INSPECTION ......... . to.()().. ........... Comfort Cooling Unit......to 3 ton/HP ................. .......... 8.00............... Forma / Foundation ............................ BY:........ . ..... . Date:................ to 15 ton/HP......................... 9.50.............. Plumbing Ground Work ................ -. ._...................................... to 30 ton/HP._...................... ..12.00. ............ ,gftugh Electrical _.................................. ............... ......... ........_................ to 50 ton/HP................. .......... 17.00.. ............ In e - Plumbing and Heating..................................... ........................... Space Healer........ Well Heater ................................... 6.00.............. Ilion & Energy.................. .......... .................................................... Flues - other than above ..............:.............................�.. 3.00.............. Test .._......... _..........__... ... .. ...... ._.. .... ..... ..........__........_.. Vent Fan: Kitchen 3.00............... ...H Bath ......................................... f"'porary Power Gas / Elect. ........ ......................... ........................... Commercial Range Hood 8.00,,,....,.,,.... .......................................... Final - Electrical ............................................................. ........................... Misc. (See Ord. Current.......................................................... ................. (nal - Building / Mechanical .............. .................................................. Permit Fee .............. . $ 6.00 ............................................pp........ Incl Design Review / Landscaping . .... . ........................................... TOTAL Hig./ Coolg. Permit Fee (plus penalty If app. Q) $ Flnel-Public Works ...........................................................