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1097 • • Y CITY OF CUPERTINO ^APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER Q 7 / 1 AND FOR APPLICANT to CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STRfVT J)SESS F OJECT: Dri 11 .v L....................................... . .... .. ............... .. IIIIIIIIIII • • • • s Legal Description: Tract.p..._...... ........ Block............ LDDL.... ............... Plans Received By Description of Work: ...Re-7n.ra.0 fc.._/._`e.SfGjP.<:7Y.�:' ........ y....................................................Date ......-.................. REQ.: Plans.... Survey.... Cafes: Struc..... Energy--.. Elect..... Mach.... 1st Structs Improvement on Parcel: Yes.... No....Area of Bldg............... Plans Checked By_............ ..... Date ..... ... Separate Structure........... or Addition/Alteration to Exist. Bldg........... Application Approved 8 .4.•_......a Date -...�_3.d/ No. of Stories....... _..... Use of Building PP PP Y ..__ .-. _ ... Y"" g ................ Validated By........ ... . ... _......__ ....Date - _.............. Valuation of Project $... cgo�f,V.�.. . . .... .... .. Compensation Certificate Verified By .. _ .. Date - _ _.. ... Owner: . ..FYO Nr ...P tl olve- .. Phone 25_.2-,14,(9 Contractor .... ...... .._...... .....City Bus. Lie. # ......... • • • • • $ Contractor's Address: .................................. Phone:.................... Permit Fee (plus penalty If applicable) Contractor - Electrical: ...................................................__....._....__....... Plan Check Fee (less deposit of$.... ..._. Rct. #..._......)$..................... - City Business License #.................... Phone:.................... Energy Plan Check Fee (Dep. of $........ Rct. #........) $..... Plumbing: ..._..._............._..........._........_._......__................_...... — Strong Motion Fee .........:... -. r••::L:• rrav _ $..........y.S�_. City Business License #.................... Phone:.................... ...._.....-.rn i......................... b.tt Heating and Cooling ......._............. ......_......_..._ ............. Plumbing Permit Fee ............................. $................-...... _ _ tU City Business License #.......__.. ........ Electrical Permit Fee ................... 1`iS'.................$...................... ....... Phone:............ Meeh. Htg./Coolg• Permit $!.��. ... Architect/Designer: ......................._......................... Phone:.................... } - . Engineer: ..._................_.................................._..._.... Phone:.................... wn Residential Construction Tax ..._._....._.. $._...... ... Lender: _.. _............... Unknown ...... ..... Mise. Fee � $....... '�� .._......._.... _...._. ..... ._. ....._........ ...._.......- .... .. "I certify that in the performance of the work for which this permit is Mise. Fee ....I_...._.._..._.............:...._....._--_ ........... $.........-....._...... d shall• qq issue s a not employ any person in any manner so as to become subject • • , $CAI S-� to the workman's co nsation laws of C ornie." a SIGNATURE OF • • APPLICANT/OWNER ............._ ._............ DATE..C.`30.�X0 Environments Status: Exempt............ Other_.._........................ .......- "I certify that as the applicant I am licensed unde the provisions of the Design Review Approval: Bldg. ............ Site ........._ Sign .. ........ Contractors License Law and further that my Licens. No. ........_................. Use Zone P.D. Conditions in Classification ......_........_...................... is in full farce and effect: or .....Permit ................_..... ......9....p..ces............ /Cord. Use Permit #..._....... Variance #............ Parkin Spaces.... I certify that I am exempt from the "Licensed Required" provisions of the Approved By. Date Contractors License Law. (State basis of exemption.t """"""""""""""""""""""""""""" """"'-""""""""- I hereby acknowledge that I have read this application and state that the above Is a, reev and agree to comply with all City Ordinances and State Laws regulating g1:11110IIIIJ303:1, building. 1A."U.r I we) agree to save, indemnify and keep harmless the City of Cupertino ndr08Chme0t Permit....................... Grant Of Easement.... against liabilities, judgments, costs and expenses which may in any way rb, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... acture against said City in consequence of the ranting of this permit." Sewer.._.......- Conn. Fee $._.......__. Water................ Meter $................ SIGNATURE OF Agreement for Completion of Public Works Improvements ......_.......... APPLI .. .. Plans Checked By...... Date........ Approved By........ Date................... NOTE: When properly validated this form constitutes a Building Permit. This permit expires and becomes null and void should work notbe commenced 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 FOR Light Outlets_...___. Switches...___... PLUMBING Fixtures.......__ Receptacles........_.. PERMIT INSTALLATION NO. EACH FEE TOTAL NUMBER (less than 1000 watts) ............ $ ,So Gas System with up to 5 outlets .................................$4,00 ............. Range........ Cooking Unit........ Oven............ ......._ .... 2.00 ............. Each additional outlet ...................................._....... 1.00............... Dryer....... Garb. Disp......... Dishwasher . ......I._.... . 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 .._..........._....._._r.......__....__....._....................... .. 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............... 0-500 sq. Ito $22.00 1501-1750 $34.50.............................. Mise. (See Ord. Current) .......... 501-750 24.50 1751-20000 37.50........................... ... .........................:....-.6.00 .... 751-1000 26.00 2001-2250 39.50.............................. Permit Fee ........._._......._......(plu_......nalt..............____-.$ 8.00 1001-1250 28.50 2251-2500 42.00.o........................*... 2.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app.Q) $ 1251-1500 32.00 2501-2750 49.50.............................. APPLICATION FOR HEATING/COOLING PERMIT - Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty it app.p) $' PERMIT INSTALLATION NO. EACH FEE Forced Air Unit............._..to 100M ..._................ ....._...$6.00............... • - • - 777 over 100M ....................... . 10.00.. ...........Forms / Fountlation . .. . B Comfort Cooling Unit.._to 3 ton/HP . .. 6.00,. . ......y to 15 ton/HP. 9.50..... .Plumbing Ground Work ...._ . j. to 30 ton/HP. .... ... . .. 12.00 .-'ough Electrical . .__ ... to 50 ton/HP. 17.00.. me - Plumbing and Heating _ . Space Heater. Wall Heater 6.00 Ilatlon & Energy .. . _ - �. -- -- Flues - other than above - 3.00.. ....... Test I - --- l- - "'.. Vent Fan: Kitchen...__ Bath .. 3.00. ��•.emporary Power Gas / Elect __ .. l Commercial Range Hood _ _ I 6.00 Final - Electrical . . .. ..... . .. .. .. Mise. (See Ord. Current... _ l Final - Building / Mechanical ....................... ............... .. . . Permit Fee ......._ .......... .__. ......................- ._.. $ 6.00 Final - Design Review r Landscaping . ...... .......................................... TOTAL Ht9 / Cool9 Permit Fee (Plus penalty It app. ❑) E Final- Public Works ---,-,„.............................