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1919 (2) CITY OF CUPERTINO PERMIT NUMBER / APPLICATION FOR RESIDENTIAL BUILDING PERMIT / _ AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION * STR?,ET %SS ®F.PROJQT. • • • . Legal Description: Tract... ...................Description of Work: ..... Blocckk....1430`f.n.�.. ......................... Lot...................... .L�! Qf:.!.SFr.... PlaneReceived By..........................:.........................Date ......................... .—.......................................................................--......................................... REO.: Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach.... 1st Stroct. Improvement on Parcel: Yes.... No... Area of Bldg............... Plane Checked By.............. . .. ... . Date ................... Separate Structure............ or Addition/Alteration to Exist. Bldg........... Application Approved B .... Date%.....�, _'..� ( No. of Stories.,.... Us I uild' g .................. ............................... ......................._ pyo Validated By.................................... ........................Date ........................ Valuation.oi r 'act' $...EY. .�............h .......................... Compensation Certificate Verified B P Y ................. Date .............o o....... Owner: ..... . ..,. ..... Phone:.................... • • ' ' • f 1,3 d a Contractor: . . ..._ ._ _ ..t...C'YE Lia • .............. ........... Contractor's Address:S/Q. .r. . . . Phone:$.Re2.-73.. Permit Fee lux penalty f applicable) 3 Contractor - Electrical: ...................--..................................................... (P l ty i PP ) ..Fitt..#---....--)$..1.................. City Business License r.................... Phone:.................... Pian Check Fee (less deposit . 5.......... Ret. #..........)$...................... Energy Plan Check Fee (Dep. of $........ Rot. #........) $....................... Plumbing: ...................................................................................... Strong Motion Fee ..........................................................$....................... City Business License r.................... Phone:.................... Plumbing Permit Fee 8....................... Heating and Cooling .................................................................. ............................................... City Business License 0.................... Phone:.................... Electrical Permit Fee ............. . $....................... Architect/Desi Designer: Phone:.................... n� 9 ....................................._.......... Mach. Hlg./Coolg. Permit 8........... ..'y�nrrpi $.......................1 Engineer: ...... ................................ .......... Phone:............... Residential Construction Tax ...... .......1./l�..$....................... Lender: . .. ........ ......... .- . . . ........................... C3 Unknown Misc. Fee ............................... ... ..." . $....../�� z" b"'�"' _.. ... '•I certify that In the peAormance of the work for which this penult Is Misc. Fee ................................................. ... $....................... issued 1 shall not employ any person in any manner so as to become subject qa • S � / � a to the workman's compensation laws of California." w� SIGNATURE OF ZONINGAPPLICANT/OWNER ....................................................................... DATE........................ Environmental Status: Exempt.:.......... Other........................................ .. -I cerlity that as the applicant I am licensed unde• the provisions of the Design Review Approval: Bldg. ............ Site ............ Sign ............ Contractors License Lew and further that my Users, No. ............................ Use Zone ............ P.D. Conditions in Classification ......................-................ is In lull force and effect: or Cond. Use Permit #............ Variance #............ Parking Spaces............ I certify that 1 am exempt from the "Licensed Required' provisions of the Approved 13 Date ........... Contractors License Law. (Stale basis of exemption.) PP Y...�������������������- '��������������� - 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 Slate Laws regulating • • building. !Ar I (we) agree to save, indemnify and keep harmless the City of Cupertino achment Permit........................ Grant of Easement........................ against liabilities, judgments, costa and expenses which may in any way -" GUttBf, Sidewalk, Driveway: Replace.......... Repair.......... acture e9elnet said City n consequ ce of the gran Ing of this permit." r............ Conn. Fee $................ WefBr................ Meter $................ SIGNATURE. OF ll, 2—rfM-!.' � Agreement for Completion of Public Works Improvements .................. APPLICANT/CON rRAcr jdA. . . .............................. DATE;2-43 Plans Checked By........ Date........ Approved By........ Date.................... NOTE: Wheh properly ted this tam constitutes a Building Permit. This permit expires end beconull and void should work not be com umiced within • • • 120 days Iron validation date, or should authorized construction be wspend•d or • • I abandoned(or a period of 120 days after work is commenced. PERMIT INSTALLATION I NO. EACH FEE , , ,LICATION FOR PLUMBING PERMIT Light Outlets............ Switches...:........ 1. Fixtures............ Receptacles............ PERMIT INSTALLATION NO. EACH FEE TOTAL NUMBER (less than 1000 watts) ............ $ ,50Gas System with up to 5 outlets .................................$4.00 ............. Range........ Cooking Unit........ Oven............ .........I...... 2.00 .............. Each additional outlet ............................................. 1,00............... Dryer........ Garb. Disp......... Dishwasher ............. 2.00 .............. Water System (Installation, Aft. 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 am ... ........................ p.,....... . 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 Flat Rate Interceptor........ Water Softener........ ........................._..4.00. ............ Plumbing Piping without fixtures ...................................4.00............... 0-500 eq, ft. 822.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) .......................... .......... ...... .......... 501-750 24.60 1751-•20000 37.50.............................. Permit Fee -.......................................................................$6.00 761-1000 28.00 2001-225C 39.60.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. ❑) f 1001-1250 28.50 2251-2500 42.00.............................. 1261-1600 32.00 2501-2750 49.50.............................. APPLICATION FOR HEATING/COOLING Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.p) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M ..............................$ 6.00............... • • ' r over 100M ....................... . 10.00.. ........... Comfort Cooling Unit......to 3 ton/HP ........................... 6.00... ............ Forme / Foundation .......................... .. BY....... . Date:............... .. .. . ..... to 15 ton/HP......................... 9.50.............. Plumbing Ground Work ....................... i..... ................ ........................... to 30 ton/HP........................ ..12.00.............. R gh Electrical ............................__....;.... _........._....... _._...................... .... to 50 ton/HP.........................M..17.00.. ........... e - Plumbing and Heating ........... ................ ........................... 6.00.. atlon 8 Ener Space Heater........ Wall Heater ...................................I ........... Tear Power Gas / Elect. . ........ ............'....._.....`.......................... Flues - other than above ............................................j.. 3.00.............. I T'amp 9y.................... . ... ................. t.......................... Vent Fan: Kitchen........ Bath ......................................... 3.00............... Yi........................... .......................................... .. 8.00............... Final - Electrical .................................... . .. Commercial Range Hood . ................................................ Misc. (See Ord. Current........................................................................... Final - Building/ Mechanical ....................................... .......................... Permit Fee ........................................................................ $ 6.00 Final - Design Review y Landscaping . ..... ........................................... TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. ❑) S Final-Public Works ...........................................................