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1456 (2) CITY OF CUPERTINOJJ APPLICATION FOR RESIDENTIAL BUILDING PERMIT RMIT NUMBER AND • . a CERTIFICATE OF OCCUPANCY FILL IN BUILDING INSPECTION DIVISION STREET D RESS F PROJECT: /.D..Z .JD...... %c k.s.8uev............ _..... _... ................... DEPARTMENT USONLY Legal Description: Trac�j........ .....f Block............ Lot...................... Description of Work: .FE.'..IZOO.. ......................I.............................. PlanaReceived By....................................................Date ......................... ........................................................................................................................ REO.: Plans.... Survey.... Calcs: Strut..... Energy.... Elect..... Mach.... tat Struct. Improvement on Parcel: Yes.... No...Area of Bldg............... Plans Checked By................................... Date ............ Separate Structure............ or Addition/Alter,yyion to Exist. Bldg........... Application Approve B ./j... �....._.Date ../°.".%..:.�3?... IG£. PP PP Y- - No. of Stories.............. Use of Building ........ . S............................. Validated By..............................................................Date ......................_ Valuation f PrPPject $$.... .!/GG.,.Q.Q.................................................. Compensation Certificate Verified By ................. Date ...-........... ..... Owner: �A(�1.....i /OC .. ... ............... Phone:4, .7r.24f $ 3yod O'er Contractor:TD.t.I�K..... , . .hCity Bus. Lic. ♦ ...... • • " • 0V Contractor's Address:L1$.?9-.. ...An1TIjA1A...... Phone:3Z11:81Gd Permit Fee (plus penalty if applicable) ........................$...;214?... Contractor - Electrical: ......... ...... Plan Check Fee (less deposit of$.......... Ret. #..........) $....................... City Business License II".................... Phone:.................... Energy Plan Check Fee (Dep. of $......r.)jct. #........)$.............. Plumbing: ....._........................_...._..................._........-............... Strong Motion Fee ....................................... City Business License e.................... Phone:.................... •/""' --'$"""'-"-.��." Heating and Cooling Plumbing Permit Fee .. $....................... .................................................................. .................. 9 .... --; City Business License a_.................. Phone:.................... Electrical Permit Fee .........................._ .......... $:...................... Architect/Designer: .........._.............. Mach. Htg./Coolg. Permit $................::.......... $....................... ........................ Phone:.................... �� Engineer: ._._....... Phone:...............wn Residential Construction Tax ..........�. _�.:..$....................... __......_........................................... ............... Lender: . .. .... ........_..._.................................... E] Unknown Mise. Fee ..................................................1...................$............d. .b.. "1 certify that in the performance of the work for which thin permit Is ,,uL�,, Mise. Fee ........................................................�....��......$....... ..f.!..._V... issued I shall not employ any person in any manner so as to become subject • $ A444-0 to the workman's compensation laws of California." I SIGNATURE OF /fn e • APPLICANT/OWNER [,�"(Gf ..........._.... OATFL..�..'�Q Environmental Status: Exempt............ Other........................................ ....... •I certify that as the applicant I am licensed under the pr vi Igns o the Design Review Approval: Bldg. ............ Site ............ Sign ........... Contractors License Lbw aid further that my Licens. No,W4X4... ...................... Use Zone ......-..... P.D. Conditions ............................................................-, in Classification ....... .. -.7.............. is in full force and effect: or Cond. Use Permit e............ Variance e............ Parking Spaces............ .. I caddy that I am exempt from the "Licensed Required" provisions of the Approved By. Date Contractor License Law. (State basis of exemption.) -- - -- - ------------- -- '-""""""""" 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 State Laws regulating • ' • binding. I (We) agree to save, Indemnify and keep harmless the City of Cupertino roachment Permit........................ Grant of Easement........................ against liabilities, judgments, coals and expenses which may in any way b, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... acture against said City In consequence o the graIle ting oI mi e per It." ler............ Conn. Fee $.-.............. Water................ Meter $................ SIGNATURE OF. L Agreement for Completion Of Public Works Improvements .................. APPLICANT/CONTRACTOR �... ......._.. .._............. DATE�! ...��Q Plana Checked By........ Date........ Approved By........ Date.................... NOTE: when properly validated this loan constitutes a Building ermlt. This permit expires and becomes null and void should work not be commemned seletN APPLICATION • . ELECTRICAL PERMIT 120 days from validation date, or Mould 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............ ................ 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 1...................................................... Vacuum Breakers ............................................ ..............3.50. ......._._ New Residential Occuponciea Flet Rate Interceptor........ Water Softener........ ........................._..4.00. ............ Plumbing Piping without fixtures ...................................4.00. ............. D-500 sq. ft. $22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) ................................................. 501-750 24.60 1751-20000 37.50.............................. Permit Fee ................................. 751-1000 26.00 2001-225C 39.50.............................. ........... ......... ..........$8.000 1001-1250 28.50 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus pennaltalty it app.Q) _ 1251-1500 32.00 2501-2750 49.50.............................. APPLICATION FOR HEATING/COOLING Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app•O) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to IDDM ..............................$8.00... ........... INSPECTION • ' r over 1 DOM....................... . 10.00.. ........... Forme / Foundation .............................. B Date:................ Comfort Cooling Unit......to 3 ton/HP ........................... 6.00... ........... By:...:........ ....... . to 15 ton/HP.................. 9.50.. . Plumbing Ground Work i..... "'"' ••• . .................... .. .... to 30 ton/HP........................ ..12.00. ............ ugh Electrical ....................................�......................... ........................... to 50 ton/HP............................17.00.. ........... e - Plumbing and Heating ................................... ........................... Space Heater........ Wall Heater ................................... 6.00.. ........... lation & Energy............................... .....................................I.............. Flues - other than above ............................................I.. 3.00.. ........... Test .......................:................... ..........................'........................... Vent Fan: Kitchen........ Bath ......................................... 3.00... ........... Temporary Power Gas / Elect. ........ ......................... ........................... Commercial Range Hood 6.00............... Final - Electrical ...........................................................�........................... Misc. (See Ord. Current........................................................................... Final - Building/ Mechanical .............. ................................................... Permit Fee .......................... $ 6.00 ..... ....... Final - Design Review / Landscaping . .... ......................'.........., TOTAL Htg./ Cool Permit Fee (Plus penal If a """"" 9• 9- penalty app. O) $ Final-Public Works ...........................................................