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1887 (2) CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER �Y AND FOR APPLICANT TO FILL IN i� CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STREgT ADDRESS OF PR04IECT: ...7:p 63---SQUAIR.EwoVIA....I,Ui4. ....r....Qi.4p�%......................... • • • - . Legal Description: Tract........................dock............ Lot...................... Description of Work: ......SPl3.............................................................. Plans Received By......:..............:..............................Date ......................... ........................................................................................................................ REO.: Plans.... Survey.... Calcs: Struc.. . Ene gy.... Elect..... Mach... 1st Strict. Improvement on Parcel: Yes.... No... Area of Bldg............... Plans Checked By.............................. ... Date .... ... ... Separate Structure............ or Addition/Alteration to Exist. Bldg........... Application Approved By...............././://{,� �.....Date . �� No. of Stories................ Use of Building .................. ............................... Validated By.....................................!�E'..................Date ........................ Valuation of Project: $.. ........... ......................................................... .... Compensation Certificate Verified By ................. Date ........................ Owner: .GAqr�� M.r....�f.NG(fl�...................... Phone:.xS 4'..iijr O Contractor:-..'.. .l.................................._..........City Bus. Lic. a .............. EMT • •• • Contractor's Address: ..............-............................... Phone:.................... p Permit Fee (plus penalty 1 / � Contractor - Electrical: .............................................................................. (P P YIp@ble) ........................$......./.-......b.. City Business License a..:................. Phone:.................... Plan Check Fee (less deposit of$...C(1 �y1_. #..........)$../c1�...0...... Ener Plan Check Fee QDe of 5..._P`i9EJ Plumbing: ...................................................................................... 9Y ,.0 )$............... ..... City Business License .................... Phone:.................... C Bu e {� Y Strong Motion Fee ................ft... ............. ....�.. 9 Heating and Cooling PlumbingPermit Fee .............. $..../ r. Q.. ........................................ne:.................... ........ 9 / Electrical Permit Fee ........... �� 81""""�"'��" City Business License #.................... Phone:.................... . .................................... X-4.0.. Architect/Desi Designer: , , Phone:.................... Mesh.Residential Construction Permit Q 9 ................................................. "1f Engineer: ...... ............................................................. Phone:.................... Residential Construction Tax .......... ............................ ................. $....................... Lender: . .. p Unknown Misc. Fee ........................................................................$....................... "I certify That In the performance of the work for which this permit Is Mise. Fee ........................................................................$...ry................... issued I shall not employ any person in any manner so as to become subject • . , , ; $ / /i S� to the workman's comp nsation IawSCalifornIa." SIGNATURE OF �`A4 /O 8� • • APPLICANT/OWNER ... .. ..'..�.... 441 ,W......... DATE......!......'....... Environmental Status: Exempt............ Other........................................ "I certify that es the applicant I am licon§ed unde• the provisions of the Design,Review Approval: Bldg. ............ Site ............ Sign ............. Contractors License Law and further that my Licane. No. ...................-....... Use Zone ............ P.D. Conditions ......................................................... in Classification ........................................ is in full force and effect: or . Cond. Use Permit s............ Variance e,,,,,,,,,_„ Parking Spaces............ 1 certify that I am exempt tram the "Licensed Required" provisions of the Approved B Date Contractors License Law. (Stale basis of exemption.) PV y"""""""""""""""""""""""""""""' """""""""""""' 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 Stale Laws regulating building. I (we) agree to save, Indemnify and keep harmless the City of Cupertino t........................ Grant of Easement....................... against liabilities, judgments, costa and expenses which may in any way alk, Driveway: Replace.......... Repair.......... acture against said City in consequence of the granting of this permit." AF= Fee $................ Water................ Meter $................ SIGNATURE OF Completion O} Public Works Improvements .................. APPLICANT/CONTRACTOR ........................................................... DATE ........................ 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 • • 120 days from validation data, or should authorized construction be suspended or abandoned for a period of 120 days offer work Is commenced. PERMIT INSTALLATION NO. EACH FEE APPLICATION O, PLUMBING 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, All. or Repair) ................. 4.00............... MOTORS: 1 HP or less .........................................I...... . 2.00 Water Closet.... Water Heeler.... Ld. Tray..................... 4.00. ............. Greater than 1 HP not more than 5 HP ........L.... 3.50 ... ..J'b 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... .1<S'n 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...F:..00 0-500 sq. ft. $22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) ..........................••••••.....:.... 501-750 24.60 1751-•20000 37.50.............................. Permit Fee ..........................................................................$ 8 00 761-1000 28.00 2001-2260 39.60.............................. TOTAL PLUMBING PERMIT FEE (plus penely if app. 1001-1250 28.50 2251-2500 42.00.............................. 1251-1500 32.00 2501-2750 49.50.............................. APPLICATION FOR HEATING/COOLING PERMII PermitFee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.p) $///r00 PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M ..............................$ 6.00... ........... ' f Over 100M....................... . 10.00.. ........... Comfort Cooling Unit......to 3 ton/HP ............................ 6.00... ........... Forms / Foundation .......................... ... By:........ .,..... . Date:............._. to 15 ton/HP......................... 9.50.. ........... Plumbing Ground Work ...................... ).... .. to 30 ton/HP........................ ..12.00.............. If#st�lan Electrical ....................................:.... /. ..-. /. Plumbing and Heating ..........I.. ....... ............ ........................... Heater../HP......................... 17.00 .......... Space Haeter........ Wall Heater ...................................�.. 6.00 .......8 Energy............................... ..... Flues - other than above ..................................... ....13.00.. ..... .eat ................................._........ m —[.Y Yl.. Vent Fan: Kitchen........ Bath ....................................... 3.00... .prary Power Gas / Elect. . ._..... ..� .._ ........_�.......�....q.. ....... Commercial Range Hood ....J..._................................I}f fi.00... . Ord. Final - Electrical ......................................... . .... . ..t.�.......f` t-r!� Misc. (See Ord. Current..... . . 1.....................� ... .... .. , ......... Final - Building/Mechanical .............. . I /7 Tf4...................... .. ...... ...................................'--- Permit Fee ....................... ............................................... E 6.00 Final - Design Review / Lantlscaping . ..... ._............... ........._............. TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. p) $/O py Final-Public Works ...........................................................