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1706 (2) CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER /7� • AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION S71 ES F MAI • • • • • Legal Description: Tracalock..... Lot// .. ....Aa lPlana Received By............._1T. .. .. .............Date3.sa.. ..�..... .L.... ...................... `f -------- ........................__........................._......._................_................ . REQ.: Plans.... Survey.... Celcs: Struc..... Energy.... Elect..... so .... 1st Struct. Improvement on Parcel: Yes.... No...Area of Bldg............... Plans Checked By............................ ..... L Date ..�y _..... . Separate Structure..-........ or Addition/Alterati n to Ist. Bldg..tr� Application Approved By.......... .... .. .... .4t, Date ...... ../J�d.1..... No. of Stories......Z.. Use Bui diqg . P..YrJ.wu.hy.... Validated B .Wd - _ _ 1111 By.................................................................Date ......... Valuatio f Pro' ct: Compensation Certificate Verified B ✓ Date /., ,.t..L - P Y ................ . .. Owner: ' ,�P,.f/ d7,r2... Phone:.................... Contractor i t��/y_. rfp!i�i,,C'I Bus. Lic. # _. ......... ' ' • ' • $ -7-7• Ol�c Contractor's Address3 v _i��G./�(/�f Phone7�-�/3 Permit Fee (plus penalty f applicable) — Contractor - Electrical: .. ........-....._........_......._......._....-..................... (P P Y i PP 1 ..Rct..#...........$.o�.....�....... City Business License #.................... Phone:.................... Plan Check Fee (less deposit of$.......... Rct. #..........)$....................... Energy Plan Check Fee (Dep. of $........ Rot. #........ $................. Plumbing: ..._...................._.........._................._.....__.................-- Strong Motion Fee ..........................................................$........5- 3.,j City Business License #.................... Phone:.................... Plumbing Permit Fee $..,'� !�c e':° Heating and Cooling .................................... ............ Electrical Permit Fee ......................................................$......, .6<,� City Bu mess License #.... ..... Pho e:...... ........... Mach. Htg./Coolg. Permit $............................. $.......or.S,.... W Architect/Designer +y7/3/' ...... Phon, """ Engineer. P Y .. Phone-... Residential Construction Tax .........................-............$................. d................. ❑ Unknown .:. ......... Misc. Fee .......................................................................$....................... •'I certify that In the performance of the work for which this permit Is Mist. Fee ........................................................................$............. ......... dshall /9r �� issue not employ any person' ony a ner so to become eubleat • ; $ -3 to the workman's c ns le C SIGNATURE OF • • APP ANT/OWNE _....... _ ....War DATE 97.. Environmental Status: Exempt ............ Other............... ............... certify at as the applicant am license unee the qf9v i�slo_ne�pI the ...... Design Review Approval: Bldg. ............ Site ............ Sign ............ Contractors License Law and further that Licena. No.S.12.3 .�.. Use Zone P.D. Conditions .................. in Classification ...... ..--......._.-............. Is in lull force and effect: or Cond. Use Permit #............ Variance #............ Parking Spaces............ - I certify that I am exempt from the "Licensed Required" provisions of the Approved B Contractors License Law. (State basis of exemption.) PP y........................................................... Date ........................... 1 hereby acknowledge that I have read this application and state that the above Is • ! :onect and agree to comply with all City Ordinances and State Laws regulating building. I (We) agree to save, indemnity and keep harmless the City of Cupertino nCroeChment Permit.__................... Grant Of E898men1......................., against tiabilitles, judgments, costa and ex noes w may In any way urb, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... acture against sale City In co eq ce h g of this permit." Sewer............ Conn. Fee $................ Water................ Meter $................ SIGNATURE OF �� )) Agreement for Completion of Public Works Improvements ............-.... APPLICANT/CONTRACTOR ...... .._ .. DATE 1:17-; :G7. Plans Checked By..-..... Date........ Approved By........ Date.................... NOTE: when properly alldalad this i constitute a Building Permit. This permit expires and becomes null and void should w not,be commenced within APPLICATION FOR ELECTRICAL PERMIT 170 daY• from validation date, or should authorized construiction be suspended or abandoned for a period 01170 days eller work Is commenced. A PERMIT INSTALLATION NO. EACH FEE APPLICATION F• , PLUMBING Light Outle��,ss.��4Switches./ .7.. Switches .7.. r Fixtu reSZG,... Receptacles-.4-43...., �C� PERMIT INSTALLATION NO. EACH FEE TOTAL NUMBER (less than 1000 watts) ._.. .. ... $ ,5o _/..! Gas System with up to 5 outlets ...............................„$4.00. ......,..r- Range,./.. Cooking Unit........ Oven../. .. 2,00 ....... ..r. Each additional outlet ......-.............................. 1.00.......... Dryer..../. Garb. Disp../... Dishwasher /.......... .... 2.00 ...... .,W Water System,(Installation, Alt. or Repair) ..........1..... 4.00.... ... ! MOTORS: 1 HP or less ........................................ . ... 2.00 ...W Water Closet,',f. Water Heater./. Ld. Tray............. ... .. 4,00: ..(ee..e/v Greater than 1 HP not more than 5 HP ..._......_.. 3.50 ..........._. Levator . Shower Pan. Bethtub2.SinkZr..._ _... 3.00. kIL Temporary Power Pole or Service — 100 amp . . ..... ..5.00 „,,,,,....... Wash. Mach./.. Dish a er.l, Garb. Disp../. ..... ...... 3.00..:..7�... —200 amp. ....... . 7.00:.............. Sewer ........... ...�.. .. .....v�F........................../...... 8.00,".4 451.- Time Clock .............................-.... ................................... 1.50...,........... Lawn Sprinkldr 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., .., ............. 0-500 sq. ft. $22.00 1501-1750 $34.50.............................. Mist. (See Ord. Current) ......,.................,.....,....,......:......... 501-750 24.60 1751-20000 37.60.............................. 751-1000 26.00 2001-225C 39.50.............................. Permit Fee ..................................-......................................$ 6.00 1001-1250 28,60 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. Q) $ W N 1251-1600 32.00 2501-2750 49.50.............................. APPLICATION •• HEATING/COOLING PERMIT r` Permit Fee...............................................$6.00 �! d TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.0) $6C - PERMIT INSTALLATION .1 EACH FEE 0 h Forced Air Unit..................to 100M ...................... ......$ 8.00,.... ....✓ over100M .......................... 10.00.. ,.......... q 4 2� Comfort Cooling Unit...._to 3 ton/HP ........................... 6.00............... Forms / Foundation ......... n�1 .. By% - .._. . Dat :.2-19-6' to l5 ton/HP......................... 9.50.............. Plumbing Q eramd"RGYk .I a S .��' •.��.�� Rough Electrical ............... ......... . .. 4.....Y. .:d./.... \ to 301on/HP.....,.................. ..12.00. ...........' ,orame - Plumbingand Heatingto a0ton/HP........................... 17.00.. .........., Space Heater..han Well Heater .............................. striation 8 Energy.............................. ..... .... .DO.........� Flues - other than above ......... ..........................2....... 3.00.... .. as Test ................ .. fes,.... i �i � l4 V t .. ......__..._......... "�'��"�� - ant Fan: Kitchen Bath .� .. �... .. 3.00...... . ........... .... . .M.Y. . .U...... y p 6.00 Commercial Range Hood .. / Final - Electrical - .. .. ................. !!.'. ..-$....... Misc. (See Ord. Current........................................ ............ P .. .................................... Final - Building/ schen' al .............. ..... Q.�...-�.......-, Permit Fee ............. ............-................ $ 6.00 @ ....... ... ................( Ina - ubli Review / Landscaping . .... TOTAL Hig./ Coolg. Permit Fee (plus penalty if app. ❑) $p27 Final-Public Works ............... . ... It* �, i3Tep- z 1 A� x 0, r 3�1,--8! �✓ i FG2L�TRyu.o.� s-y41 2 �R2 x'r O--1 a.ao�S',o-�rQ�