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1916 (2) CITY OF CUPERTINO CITY OF CUPERTINO FEB 191981 APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER AND . APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION TREET�+DDRESS QF PROJECT' ...._ L .. Ztoe....L+.�l..._. C,.U.PEP_,.T.n.40........... r • • • Legal Description; Tract.. ....... IOck............ Lot...................... Description of Work:�....R k ..917 ........... PlansReceived By....................................................Date ......................... REO.: Plans.... Survey.... Cafes: Struc..... Energy.... Elect..... Meeh.... 1st Struct. Improvement on Parcel:Yes.... No...Area of Bldg............... Plans Checked By.................................. Date ...........AA.... Separate Structure............ or Addition/Alteration to Exist. Bldg........... Application Approved By................*. .. .r..�........Date ..Z.I.J/./,Qr/� No. of Stories................ Use of Building .................. ............................... Validated By..............................................................Date ........................ ValuationJ;f P�o' Compensation.n C.rtific tte Verified 9 ................. Date ......................... Owner i of 1. .. 0.1��4.......p.. ... ............... Phone:.................... Permit Fee (plus penalty If applicable O Contractor: :.. ddr s>....SOp...n.....?f YXjCity Bus. LIC. R ............. P Y oa Contractor's Atltlress T............_...................._........... Phone[]:.353.13�i ........................$.a.........—... Contractor - Electrical! .............._._._..............—........_...__..................._. Plan Check Fee (less deposit of$.......... ROL #..........)$....................... City Business License #.................... Phone.................... Energy Plan Check Fee (Dep. of $........ Rot. #........)$....................... Plumbing: ...........................................................---........................ Strong Motion Fee ..........................................................$............. City Business License #.................... Phone:.................... Heating and Cooling ..........#............................ne:.................... Plumbing Permit Fee ................................................ ....................... City Business License +.................... Phone:.................... Electrical Permit Fee ...::............................................... $....................... Architect/Desi Designer: Phone:.................... Mach. Ht9./Coolg. Permit $............................. $....................... g ................................................. Residential Construction Tax ........................................$....................... Engineer: .,..,.................... .......................................... Phone:.................... _ Misc. Fee ..... Lender: _ .._....... ..................................................----..... ❑ Unknown """"""'-"""""""-"""""""""""""""-""""""$"""' "1 certify that In the performance of the work for which this permit Ie Mise. Fee ....:...................................................................$........L............ issued 1 shall not employ any parson in any manner so as to become subject • $� ✓_ �� to the workman's compensation laws of California," T SIGNATURE OF • • APPLICANT/OWNER ............................................. DATE........................ Environmental Status: Exempt............ Other........................................ "I certify that as the applicant I am licensed uncle- the provisions of the Design Review Approval: Bldg. ............ Site ............ Sign ............ Contractors Licens d Ther that my Ucens. No. ............._........... Use Zone ............ P.D. Conditions ............................ in Classification .. is in.lull force and effect: or . ..�........ Cond. Use Permit #............ Variance #............ Parking Spaces............ - I cenify that I afn exempt from the "Licensed Required" provisions of the Approved B Contractors License Law. (State basis of exemption.) PP Y . ............................................. Date ........................... I horeby acknowledge that I have read this application and state that the above Is correct and agree to comply with all City Ordinances and State Laws regulating • ' • buld,nq. I (We) agree to save, Indemnify and keep harmless the City of Cupertino I11b, roachment Permit........................ Grant of Easement..................I..... against liabilities, judgments, costs and expenses which may In any way Gutter, Sidewalk, Driveway: Replace.......... Repair.......... acture against said City In consequence of the granting of this permit." ar............ Conn. Fee $................ Water................ Meter $.............. SIGNATURE OF .�tV»' yY�-__ Agreement for Completion of Public Works Improvements .................. APPLICANT/CONTRACTORR !�a_f 0:�1LLGUYVCL napv71DATE Plans Checked By........ Date........ Approved By........ Date.................... NOTE: when properly validated this form constitutes a Building Permit. This permit expires and becomes null and rob should work not be commenced within • • 120 days tram validation date, or should authorized construction be swpended or abandoned for a period of 120 days alter 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. Cap......... 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 Residential Occupancies Flat Rate Interceptor........ Water Softener........ ........................._..4,00. ............ Plumbing Piping without fixtures ...................................4.00. .•„_•„••••• 0-600 aq. ft. $22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) .......................... 501-760 24.50 1751-20000 37.50.............................. ................................................... 501-760 If 6.00•"• Permit Fee ............................................................._.........:.$8.00 751-1000 26.00 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 FORHEATING/COOLING PERMIf Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.0) $ PERMIT INSTALLATION N0. EACH FEE Forced Air Unit..................to 100M ............................ .$8.00... ........... e e • r 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 Ion/HP......................... ..12.00. ........... ughElectrical ...................................;...__...._....................................— to 50 tori......_................ 17.00.. ........... me - Plumbing and Heating .......... Space Heater........ Wall Heater ................................. 6•�.. ........... I ulation 8 Ener ... ................. ....................._. 9Y..................... ... .... Flues - other then above ............................................�-. 3.00.. INS Test ............. ...................... ....... ... ....................... .......................... Vent Fen: Kitchen........ Bath ......................................... 3.00... Temporary Power Gas / Elect. ........ . .......... Commercial Range Hood 8.00 - Final - Electrical .................................. . .......................................... .. .. ........... ..................... .......................... Misc. (See Ord. Current............................................... ........................... Final - Building/ Mechaniral .............. ........ ................L.........................• Permit Fee .. .. S 6.00 ................ .. .................................................. Final - Design Review / Landscaping . ... ................ .......I.................. TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. p) It Final—Public Works ...........................................................