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1931 (2) CII'( OF. CUPERvAo CITY OF CUPERTINO FEB 1981 PPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER AND - FOR APPLICANT CERTIFICATE AND OCCUPANCY BUILDING INSPECTION DIVISION ST A R S OF PRO ECT: ` �by.Ai°.. .q.u.Irz�L�000...w a.�l....................................... • • • • • Legal Description: Tract........................ Block....:....... Lot...................... l,�W�r�c• ..... . . Plena Received By....................................................Date ......................... DeserlptjpgA .............F_V.KI,IHC.C............R. P.......� m.�W..h)T.......................... REQ.: Plana:... Survey.... Cales: Struc..... Energy.... Elect..... Mach.... tat Struct. Improvement on Parcel:Yes.... No.... Area of Bldg............... Plane Checked By....................................................Date ......................... Separate Structure............ or Addition/Alter y(QLi t OExist. Bid Application Approved B KSS PP PP Y.........................................Date ......................... No. of Stories................ Use of Building .... . ( Ffl. Validated By.....................................5................---...Date ................:....... Valuation ro'a .:......... Compensation Certificate Verified B �11 ........................................ P Y ................. Date ............,............ Owner: ._. .[n'1 ... Phone - 1 e e • • s Ciontractor:..VAr . � . IF4. N.0--c Bus. Lic. # Contractor's Address: . h`�''�']'�8 n.j. tb...S- Permit Fee (plus penalty if applicable) ........................$..................... Contractor - Electrical: S14LD�S�.y.. .�....`.y 71 .......... Plan Check Fee (less deposit of$.......... Rct. #..........)$....................... City Business License e.................... Phone:.................... Energy Plan Check Fee (Dep. of $........ Rct. #........)$....................... Plumbing: ............ ....................................................... Strong Motion Fee ..........................................................$....................... City Business License *.................... Phone:.................... Plumbic Permit Fee $....................... Heating and Cooling .................................................................. Plumbing ................................................ City Business License e.................... Phone:.................... Electrical Permit Fee ......................................................$.......-..1......� Architect/Designer: ..................................-.:..........- Phone:.................... Mach. Htg./Coolg. Permit $............................. $..../Ol..x........ Engineer: Phone:.................... .................................................................... Residential Construction Tax ........................................$....................... Lender: .. ...... .... E] Unknown . ............ ......................................... IaC. Fee ........................................................................$....................... "I certily thatshpt performance in the Pertormence of the work for which This Dennit la Misc. Fee ............... .... ... issued I shall not employ any person f any manner so•ee to become sublet! ' s $ to the workman's compensation laws of California." SIGNATURE OF • • APPLI NT/OWNER ........_......................... DATE........................ Environmental Status: Exempt............ Other........................................ .... l certify that as the applicant I am licensed uncle- the prpp''I�''fqqpp99 �1yp9� Design Review Approval: Bldg. ............ Site ............ Sign ............ Contractors License aw iy��qq.l1yqnher that my Licens. No.p 59144h Use Zone ............ P.D. Conditions in Classificallon ..._ p.11........._. Is In full force and effect: or .......................................................... Cord. Use Permit •............ Variance 0............ Parking Spaces............ . . I certify that I am exempt from the "Licensed Required" provisions of the Approved B Contractors License Law. (Stale basis of exemption.) PP y........................................................... Date ........................... I hereby acknowledge that I have read this application and stale that the above la • s• • AUect-and agree to comply with all City Ordinances and Slate Laws regulating budding. .-. r I (We) alias to save, Indemnify and keep harmless the of Cupertino - D9Chment Permit........................ Giant Of Essenlent........................ e9elnet liabilities, judgments, costa and expenses whichch may In any way - Gutter, Sidewalk, Driveway: Replace.......... Repair.......... acture e9elnet sold City In consequence of the granting of this rmi ." or............ Conn. Fee $................ Water................ Meter $................ SIGNATURE OF � /�,., a/'p//BQ f� Agreement for Completion Of Public Works Improvements .................. APPLICANT/CONTRACTOR !ut-A/. .......... DAT69.jr/ _!{../. Plans Checked By........ Date........ Approved By........ Date.................... NOTE: when properly validated this form conslllules a avllding arm[. TNIs permit expires and becomes null and void should work not be commenced within APPLICATION •- ELECTRICAL PERMIT 120 days from validation date, of should authorized construction be suspended or 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. ............. 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. (see Ord. current)...................................................... Vacuum Breakers ............................................ ..............3.50. ............ New Resitlential Occupancies Flat Rate Interceptor........ Water Softener........ .............................4.00. ............ Plumbing Piping without fixtures ...................................4.00.. ............. 0-500 eq, ft. $22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) .................................................... 601-750 24.60 1751-20000 37.50.............................. Permit Fee ..........................................................................$6.00 751-1000 26.00 2001-225C 39.50.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app.0) $ 1001-1250 29.50 2251-2500 42.00.............................. 1251-1500 32.00 . 2501-2750 49.50...................... APPLICATION FOR HEATING/COOLING PERMIT PermitFee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app•O) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M .............................$S,GD"' '•5 INSPECTION RECORD over 1 OOM....................... . 10.00.. ........... Comfort Cooling Unit......to 3 ton/HP ........................... li.Oo... ........... Forms / Foundation .........................._.. By:._..... ....... . Date:................ to 15 ton/HP......................... 9.50.............. Plumbing Ground Work ...................... 1..... ......._ ............ to 301on/HP......................... ..12.00.............. h Electrical .....I........................ ! _....�................_...... .......................... to 50 ton/HP.........._............. ..17.00............... e - Plumbing and Heating ..........I . ........................... Space Heater........ Well Heater ................................... 6.00 scion 8 Ener 1 9Y.............................. .................................................... Flues - other than above ............................................).. 3.00.. ........... Test .......................................... . ........................'......................... Vent Fan: Kitchen........ Bath ......................................... 3.00... ........... 1111porary Power Gas / Elect. . ........ ......................... ........................... Commercial Range Hood 6.00,,,..,,_,..,,,, 4 .......................................... .. Electr Final - Building ............................................................I........................... Misc. (See Ord. Current............................................... ..,........................ Final - Design ng/Mechanical ............ ...................... ........................... Permit Fee $ 6.00 ........................................................................ Final - Design Review / Landscaping . ..... ................ ...... ..I.................. TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. ❑) Il Final-Public Works ...........................................................