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1546 (2) -A CITY OF CUPERTINO C;711 C7 ((�� _PPLICATION FOR RESIDENTIAL BUILDING PERMIT'0 ( 1 ���� PERMIT NUMBER AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY )7 / BUILDING INSPECTION DIVISION STREET ADWRES ppF PgOJECT' 14.4.1.7....... t.K...(':n9......ova-d.............................................. • • Legal Description: Tract.............. ._../.. 810Ck...... ..... Lot.. ............. Description of Work: .1?Cra.Q.�i.'f+Pry...d.f....�/�key..rC<.O.f1C.j1/ Plans Received By....................................................Date ......................... REQ.: Plana.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach.... let Struct. Improvement on Parcel: Yes.... No... Area of Bldg............... Plans Checked By.............................. Date ..... .... ... G. Separate Structure............ or Addition/Alteration to Exist. Bldg........... Application Approved By................�7.-....L�...._...Date .I�3.!.fpu.. No. of Stories................ Use of Bu1'ldinBB Validated By..............................................................Date ........................ Valualio of Prolec � $..... 006..V.Q................................................ Compensation Certificate Verified By ................. Date ....................... Owner: Re49,�*��.n+ .. .�1SSQG................ Phone:.................... • • contractor::MC�'Q r.1th��LL.,,i sp/�..'[f#.^^.t�a, h.City Bus. Lic. #".............. MffTTVYT1 $ Contractor's Address: ."Z.CI.O54#.. ..p1vc(....... Phone:..7.X1-0.3.W Permit Fee (plus penalty if applicable) Contractor - Electrical: ............. .............. ...... ..................................... Plan Check Fee (less deposit of$.......... Rot. #..........)$....................... City.Business License #.................... Phone:.................... Energy Plan Check Fee (Dep. of $........ Rot. #........)$....................... Plumbing: ...................................................................................... Strong Motion Fee ................................................ City Business License #.................... Phone:.................... "........$..........t.,�....... Heating and Cooling ............ PlumbingPermit Fee $....................... ............................... :.................... ................................................ City Business License #.................... Phone:.................... Electrical Permit Fee ..:...................................................$....................... Architect/Designer: .......... Phone:.................... Mach. Htg./Coolg. Permit $............................. $.................""" ...................._............_. Engineer: Phone:........Unknown Residential Construction Tax ....................: $....................... 9" .................................................................... ...... """""'-."' Lender: . .. . . ❑ Unknown Misc. Fee ...........__. ........._............................................. ...................'--..................................................$........ Misc. Fee $. �....�... "" " " "I certify s that In the y any person of the work for which this permit Is '"""""""""'""""""""""""'"""""""""""""�'"�� ��-� -����������•• issued I shell not employ any person in any manner so as to become sublet( • $a-6,4-V to the workman's compensation laws of California." SIGNATURE OF ,. • • APPLICANT/OWNER ......................................................................... DATE........................ Environmental Status: Exempt............ Other........................................ -1 certify that as the applicant I am licensed unde the provisions of the Design Review:.Approval: Bldg. ............ Site -......... Sign ............ Contraclors License Law and further that my Licens, No. ............................ Use Zone P.D. Conditions In Classification ...................................- is in full force and effect: or Cond. Use Permit #............ Variance #............ Parking Spaces............ I codify that 1 am exempt from the "Licensed Required" provisions of me Contractors License Law. (Slate basis of exemption.) Approved By........................................................... Det0 ........................... 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 Slate Laws regulating • building. I (We) agree to save. Indemnify and keep harmless the City of Cupertino CroaChment Permit..:..................... Grant Of Easement........................ against liabilities, judgments,costs and expenses which may in any way b, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... acture against said City In cynse t�enc f the granting of this permit." er..:......... Conn. Fee $................ Water................ Meter$................ SIGNATURE OF MCC.&L vg,.��pte/sr Agreement for Completion Of Public Works Improvements .................. APPLICANT/CONTRACTOR .: �Nn!�..c%.'.k f,L,""" /,,,�x��ATE Plans Checked By........ Date........ Approved By........ Date................... NOTE! When properly validated this tam constitutes a Building Permit. This permit expires and becomes null and void should work not be commenced within APPLICATION • • ELECTRICAL PERMIT 120 days from validation dab, or should authorized construction be suspended or abandoned for a period of 120 days after work Is commenced. PERMIT INSTALLATION NO. EACH FEE APPLICATION FOR PLUMBING PERMIT Light Outlets............ Switches............ Fixtures............ Receptacles............ PERMIT INSTALLATION NO. EACH FEE TOTAL NUMBER (less than 1000 watts) ............ g •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 ............................................ ...............I...... . 1.50............... Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00..................... ............. Misc. fees Ord: current)...................................................... Vacuum Breakers ............................................ ..............3,50............-. New RBsitlenliel Occupenciee Flat Rate Interceptor........ Water Softener--.-,.,- .............................4.00. ............ Plumbing Piping without fixtures ...................................4.00. ............. 0-500 sq. It. $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 2001-225C 39.50.............................. TOTAL PLUMBING PERMIT FEE (plus penalty If app. ❑) $ 1001-1250 28.50 2251-2500 42.00.............................. 1251-1600 32.00 2501-2750 49.50.............................. APPLICATION Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.ci) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit,.................to 100M ..............................$6.00............... INSPECTION • ' e over 100M ....................... . 10.00.. ........... Comfort Cooling Unit......to 3 ton/HP ........................... 6.00... ........... Forms / Foundation ......................._..... By:........ ....... . Dale:................ to 15 ton/HP........................ 9.50.............. tubing Ground Work ._..._.............. L.... .......__..... ..._....._...... . --" to 30 ton/HP.................. gh Electrical ........................ ..._.. ..12.00.............. _....._...,....__................_ .........._............... to 50 ton/HP....................... ..17.00.. ........... full:t�dp lumbing and Heating .......... . .................. Space Heater........ Well Heater ................................... 6.00& Ener " '•'•"""'........... .9Y............................... ............... . . ................. Flues - other than above .......... .. .... ....�.. 3.00.............. Test ....................................... ... ........ . . .......................... Vent Fan: Kitchen........ Bath ....................................... 3.00............... torar Power asG / Elect. . .. ... .............Y .... ........-............. .. Commercial Range Hood ................................ Final - Electrical ................................. 8 00 ...................................................... Misc. (See Ord. Current........................................I.................................. Final - Building/ Mechanical ....................................... .......................... Permit Fee ........................... S 8.00 ... ..... ....... (nal - Design Review / Landscaping . ..... ........................................... TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. ❑) $ Final-Public Works ...........................................................