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1948 (2) CITY OF CUPERTINO GI7Y V. CUI'6RTIN0 PPLICATION FOR RESIDENTIAL BUILDING PERMIlpn BOO PERMITAND FOR APPLICANT TO FILL IN NUMBER CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISIONT ADpBESS OF gROJECT: .,� .,.�i4aaL.t.1.....Ca.r JC.....C2. ::......Lc..p........................... • . • , Legal Description: Yract...A.................... Block........... Lot...................... Des riptIon of ork: . .je,1"dr./..../!.'.s.,r c�......0a.t ............. PlansReceived By....................................................Date ......................... S .L./.......w�. w_.e_�................................................................................ REO.: Plana.... Survey.... Coles:.Struc..... Energy.... Elect..... Mach.... tat Struct. Improvement on Parcel:Yes.... No... Area of Bldg............... .Plans Checked BY....................................................Date ......................... Separate Structure............ or Addition/Alteration to Exist. Bldg........... Application Approved BY.........................................Date ........1................ No. of Stories................ Use of Building .................. ............................... Validated By..............................................................Date ........................ Valuation of Project: S ;./. Tl.. P y ................. "i° Owner: e.m.!De.:l:.. ....... . ..._y............... Phone:.................... Compensation Certificate Verified B Date ........................ � (-Fc,. �. N,...,,,-- • • , Contractor: ..ri,.r...e.�yeity_Bus, Lid. r .�_....... $ �(3•-O Contractor's Address: .`r, ...... :. '..`.XS .�hhone:../v..e.S(a8x.'.fs3 3 Permit Fee (Plus penalty if applicable) ........................ Contractor - Electrical: .................... ...............-...................................... Pian Check Fee (less deposit of$.......... Rct. #..........) $....................... City Business License a................._.- Phone:.................... Energy Plan Check Fee (Dep. of $........ Rct. #........)$....................... Plumbing: -................................................................................... City Business License a.................... Phone:.................... Strong Motion Fee ...................................................._....S_....../-.Q.a.... Heatingand Cooling Plumbing Permit Fee $... ..(J...O�..... 9 ........................................... :.................... Electrical Permit Fee ......................................................$........................ City Business License #.................... Phone%................... Mach. Htg./Coolg. Permit $............................. $....................... Architect:Designer: .................................................. Phone:.................... Residential Construction Tax ........................................$....................... Engineer: ................-................................................. Phone:...............wn Lender: ... .......................................................................... ❑ Unknown Mise. Fee ........................................................................$....................... "I cedily that in the performance of the work for which.this permit is Misc. Fee ........................................................................ .................-.�..T. issued I shall net employ any person in any manner so as to become subject • $o(�13 y 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 prO3y1S1p�na pf the Design Review Approval:, Bldg. ............ Site ............ Sign ............ Contractors License�Law gnd�unppay that my Licens, No, .S3S- .......... Use Zone ............ P.D. Conditions ............................. in Classificatiat ...1'.?GSf..CQ.Is in full force and effect: or Cond. Use Permit x............ Variance •............ Parking Spaces............ I certify that I am exempt from the "Licensed Required" provisions of the Approved BY......:............................ - Contractors License Law. (State basis of exemption.)Dale ........................... I horeby acknowledge that I have read this application and stale that rho above Is ccrmct and agree to comply with all City Ordinances and Stale Laws regulating • building. I (We) agree to save, indemnify Permit........................ Grant of Easement........................ against liabilities, judgments, costs ez and keep harmless the City of Cupertino tachrilnses which may in any way Gutter, Sidewalk, Driveway: Replace.......... Repair.......... acture against said City In cc a ce t granting of this permit." r............ Conn. Fee $................ Water................ Meter $................ SIGNATURE OF Agreement for Completion of Public Works Improvements .................. APpucaavcoNTRACT .. .. .._.........._..._.... DATE Plans Checked By........ Date........ Approved By........ Date.................... NOTE: when properly validated this roan constitutes a Building Perni This permit expire, and becomes null and void should work not be commenced within , • - 120 days from validation data, or should authorized construction be suspended of abandoned for a period of 120 days after work Is commenced. PERMIT INSTALLATION NO. EACH FEE APPLICATION ,. 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....'r......... 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 ........................................................._....I........ 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 Rete 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 24.50 1751-.20000 37.50.............................. Permit Fee ..........................................................................$6.00 751-1000 26.00 2001-2250 39.50.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. ❑) $ d 1001-1250 28.50 2251-2500 42.00.............................. 1251-1500 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............... • . RECORD over LOOM ....................... . 10.00.. ........... Comfort Cooling Unit......to 3 ton/HP ........................... 6.00... ........... Forms / Foundation.............................. BY:........ .._... . Date:.._............. to 15 ton/HP........................ 9.50.. PlumbingGround Work ........... ..............._..._ )..... ..._........... .. ..__...._.......... 10 30 ton/HP...........................12.00.. ........... h Electrical .........................._........f... .................._. .._...................... to 50 ton/HP......................... ..17.00.. e - Plumbingand Heating ........... """"• 9 .......... ......................... ........................... Space Heater........ Wall Heater ...................................I 6.00.............. I atlon & Energy..............................1.........................�........................... Flues - other than above ............................................ .. 3.00 -Test ............................................ . ....................... .......................... � 3.00... ........... Vent Fan. Kitchen........ Bath .........................................orary Power Gas / Elecl. . ........ ......................... .I......................... Commercial Range Hood 8.00.,.,.,,..,,,,.. Final - Electrical .................................... .......................................... .. Misc. (Sae Ord. Current........................................................................... Final - Building/Mechanical ....................................... ..........-.............. Permit Fee ........................................................................ $ 6.00 Final - Design Review y Lantlscapin. . ..... ............................................ TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. ❑) $ Final-Public Works ................ ......................................... Nom- g