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1883 (2) CITY OF CUPERTINO CITY OF CUPERTINO FEB A 1981 PPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STREETESS F PRO ECT' 1.7` /i..Q..../.......�-s..F.... y gel ascription: Trac ..................... Block............ Dt...................... Descr tion of Work' '�C�... —�, D:.'.1[_/�./4..... .. .00/y................ Plans Received By....................................................Date .................. .. ..F/QE�.G..Lt.,l .................. ...... ............................................. REO.: Plena.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach.... 1st S ruct. Improvement on Parcel:Yes.... No... Area of Bldg............... Plans Checked By................................. Date 1111.... .. . Separate Structure............ or Addition/AlteratSo� Exist. Bldg........... Application Approved By.................�{.-..�.«........Date ..�'..<V .�/...... No. of Stories......./...... Use of 9ujlding ......v .. ............................... Validated By ��1.....--- Sc'u ...................................... y..............................................................Date 1111.................... Valuation 0 Pr )e t' $./,`f . Compensation Certificate Verified By ................. Date ......................... Owner. /� ...... . ....NL Phone:. • • • • • Contractor./`FA(/Y.►/1' .y. e�FjN _City Bu . Lie . . :... $ / S4 SSD Contractor's Address: 0 �•. . ./Q,�mQ.f.�..4�!�1: honeT.�.C.�rQ / Permit Fee (plus penalty If applicable) ...................:. $./>S..a"0.... Contractor - Electrica: ............................................................................. Plan Check Fee (less deposit of$.......... Ret. #..........)$....................... City Business License a.................... Phone:.................... Energy Plan Check Fee (Dep. of $........ Rcl. #........)$....111........1 Plumbing; ..............................0............................. e:.................... Strong Motion Fee ..........................................................$...........11x 1 .. City Business license 0.................... Phone:.................... PlumbingPermit Fee $....................... Heating and Cooling ........................................_......................... ................................................ City Business License a.................... Phone:.................... Electrical Permit Fee ......................................................$....................... Architect/Designer: Mach. Htg./Coolg. Permit $............................. $....................... .............. Phone:.................... ResidentialConstruction Tax ........................................$....................... Engineer: ...................................................1111........... Phone:...............wn Misc. Fee $........ 1111.. Lender: . ertify...................................................................... EJ Unknown """"".."".."""""""..""""""""""""""""""" "I cortilY that in the performance of the work for which this Permit Is Misc. Fee $... ,O..O.. ... .. •�-^�^^��^---�-��--����-�-�����'������--���-���--" �---��-�-�� issued I shall not employ any person in any manner so as to become subject • $of /i.4 to the workman's compensation laws of California." SIGNATURE OF ZONING a APPLICANT/OWNER ....................................................................... DATE ........ Environmental Status: Exempt............ Other....................................... 'I certify that as the applicant I am licensed unde- the pr isior�{$g of the Design RBVIBW Approval: Bldg. ............ Site ............ Sign ............ Contractors Licen Lgpw• an unher that my Ueomi. No. . ..-.3. Use Zone ............ P.D. Conditions .........._....... in Classification, (i.JJ.. .. ............. is In full force and enact: o Cond. Use Permit e............ Variance 0............ Parking Spaces............ 11 1 certify that 111.am exempt from the "Licensed Required" provisions of the Approved By. Date Contractors License Law. (State basis of exemption,) -""""-"- "'•'----""""""""""""""' """""""""""""' I hereby acknowledge that I have read this application and state that the above is • .:orrect and agree to comply with all City Ordinances and State Laws regulating building. I (We) agree to save, Indemnify and keep harmless the City o1 Cupertino oachment Permit...............`......... Grant of Easement........................ against liabilities, judgments,costa and expanses which may in any way v.Itr Gutter, Sidewalk, Driveway: Replace.......... �e'p... secure against said City in.consequence of the granting of this permit." ............ Conn. Fee $................ Water................ Meter $................ SIGNATURE OF � /y� f� Agreement for Completion of Public Works Improvements .................. APPLICANT/CONTRACTOR`M/V"'- �!/ .. ........_... DATE I ..7 .._ Plans Checked By........ Date........ Approved By........ Date.................... NOTE- When properly validated this form e...tllulits a' u ng Permit. This permit expires and become null and void should work not be eommemcad within • • 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 �. 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............ ....1.......— 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 ..11—....... 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 ............................................................................... 6.00............... Time Clock .........................-........ ..1.......... ........I...... . 1.50............... Lawn Sprinkler Sys. $5.00 Ea. add sys. $2.00..................... ............. Misc. (see Ord. currant)...................................................... Vacuum Breakers ........-.................................. .........]::-3.50............New Residential Occupancies Flet Rete Interceptor........ Water Softener........ ........................ ..4.00. ............ Plumbing Piping without fixtures ............................. ....4.00. ............. 0-600 eq. ft. $22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) .......................... 501-750 24.50 1751-20000 37.50.............................. Permit Fee ..........................................................................altap $8.00 751-1000 28.00 2001-225C 39.50.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. ❑) S 1001-1250 28.60 2251-2500 42.00.............. 1251-1500 32.00 2501-2750 49.50.............................. APPLICATION FOR HEATING/COOLING PERMIl' Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.p) $ PERMIT INSTALLATION NO. EACH I FEE Forced Air Unit..................to 100M ..............................$ 6.00............... INSPECTION RECORD over 100M.......................... 10.00.. ........... Comfort Cooling Unit......to 3 ton/HP ....................1111... 6.00... ........... Forms / Foundation ........... . ... _ By:-. ..... ....... Date:. .............. to 15 ton/HP..._.................... 9.50.............. Plumbing Ground Work . 1.—......... ... . :. .. ....................._............._.... to 30 ton/HP........................ ..12.00.............. hElectrical ..........................--......;... ..................... ..... .. to 50 ton/HP.................1111...f..17.00.. ........... e - Plumbing and Heating ..........1 Space Heater........ Well Heater ................................... 6.00 ........... ation 8 Energy............................... ......................... ........................... Flues - other than above .............................................�.. 3.00.. Test ...................................1111... J.*� . . ................'.......................... Vent Fan: Kitchen........ Bath ......................................... 3.00............... 4"Iforary Power Gas / Elect. ....... ..................... ...1...1.1.1............... 6.00Final - Electrical ................................... Commercial Range Hood ...................................1111... .. ............... Final - Building/Mechanical ............ Mise. (See Ord, Currant.................................................................................. ........................... Permit Fee ................................... .. $ 8.00 Final - Design Review / Landscaping 111. ........................................... TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. 0) S Final—Public Works ...........................................................