Loading...
1322 CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER ,. AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STREET ADDRESS OF PROJECT: 10e.l . .......tea ..t2vzLn ......_........_..._..... r • • • • Lega Description: Tract .._............J'+ Block............ LPL....._............ Description of Work: .a.e,.T.Oo_tr.f..�.G......(..1�./J:.e Plans Received By...... ........................._.................Date ......................... J REO.: Plans.... Survey.... Gales: Struc..... Energy.... Elect..... Mach.... 1st Struct. Improvement on Parcel: Yes.... No.... Area of Bldg...2.). .., Plans Checked By...................................................Date .................. Separate Structure.._....'... or Addition/Alteration to Fxist. Bldg.......... Application Approved By..._.................................... Date ........................ No. of Stories.._. ......... Us Of�By il-ding .../�'.@„S.r. �s7-.�.s-�.._... Validated By......................_.................................._.Date -...._._............ Valuation of Project: d�('�L�.._......_........... ........_. Compensation Certificate Verified B Date ........... -----P Y ..........-.... Owner: • • • • ' $ �� Ow n Q.T/�1/ Contractor: 6-2 .. _ - ......11 Phone City Bus Llc Contractor's Address ;)-0-5 7.[L,rRPhone:. # ....... Phone p Contractor - Electrical: ...... ........ ......-............._........... ... .._...... __ ......... Permit Fee (plus penalty if applicable) ......._...............$.S�sf......,. Plan Check Fee (less deposit of$_..._... Rct. #.__.....)$................_.... City Business License #.................... Phone:.................... Energy Plan Check Fee (Dep. of $........ Rct. #........)$......._...... ..._ Plumbing: ....................................................... _..................._.... Strong Motion Fee ....................-........_...._....._.,. . $....._.e.- ... City Business License #................... Phone:...__............ CT( G'c CU,-EI, ....... Heating and Cooling ...._......_................... ............_._.......... Plumbing Permit Fee .._..._.................._................_$......_........ City Business License #. .... Phone:.................... Electrical Permit Fee ................. ......_...._._......_ ..._._ $............_.__.... Architect/Designer: ........._..............-..........._......... Phone:.................... Mach. Htg./Coolg. Permit $.......!�1l.tr. -7.1�o$......_......___... Residential Construction Tax ........J.)U u.• .:...$............_.__.... Engineer: ......._........._..._...................._...._.._._........ Phone:................... ................... Lender: ... ......-.................._...... ....... ...._................... .... ❑ Unknown Misc. Fee ..... ........ _....... ...... ... .$..... . _ "I certil that in the performance of the work for which this c..-.0 issued I shall not employ an person in an manner so as to become subject t 13 Mise. Fee .............................�.....A,... .... $. . .. () .... ............... • E-3 (� to the workman's compensation laws of California," SIGNATURE OF • • APPLICANT/OWNER .........................._.............._.........._......- .... DATE............-.......... Environmental Status: Exempt ......... Other..._......__ ........ .. "I certify that as the applicant I am licensed undothe pro isions�I the Design Review Approval: Bldg. ............ Site .... ... Sign ... ........ Contractors License.}}aw anq further that my Loans, No. _.. -.-...S.c.......... Use Zone ......--. P.D. Conditions ................ - ..._........... in Classification .._J.�Z.( O.y..... is in full force and effect: or Cord. Use Permit #............ Variance #.....__... Parking Spaces...._...... I certify that I am exempt from the "Licensed Required' provisions of the Approved B Date Contractors License Law. (Stale basis of exemption.) PP Y - - ---- --'-""""""" """"""-""'---""" 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 • • building. 1 (we) agree to save, indemnify and keep harmless the City of Cupertino ,f08Chment Permit........._....__..... Grant Of Easement............. ....._... against liabilities, judgments, costs and expenses which may in any way loorb, Gutter, Sidewalk, Driveway: Replace.......... Repair. ...... secure against said City in consequence of the granting of this permit.'' Sewer............ Conn. Fee $................ Water................ Meter $_-.....__.... SIGNATURE OF Agreement for Completion of Public Works Improvements .........--..... APPL ICA NT/CONTRACTOR L�`-�-K � •.�!�(�.�ATE .C�.. .5/. . Plans Checked ey........ Date.. .... Approved By........ Date.................... Nora: when properly validated this form constitutes a Building Permit. This permit expires and becomes null and void should work not be 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 APPLICATIONe • 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. 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 L...... ..5.00 .,..._.....- Wash. Mach..... Dishwasher.... Garb. Disp..... ..... .... - 3.00............... —200 amp.14...... _ 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 Occupancies Flat Rate Interceptor........ Water Softener........ ---........... ............4.00. ............ Plumbing Piping without fixtures ...................................4.00_.............. 0-500 sq. ft. $22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current 501-750 24.50 1751-20000 37.50............ 1 ..........................................6.00.... .................. Permit Fee ....._........_........_. ................_.......:..................$ 6.00 751-1000 26.00 2001-2250 39.50.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app.Q) $ 1001-1250 28.50 2251-2500 42.00.............................. 1251-1500 32.00 2501-2750 49.50.............................. APPLICATION FOR HEATING/COOLING PERMIT Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.p) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit.,................to 100M ...........--..............$6.00............... • • RECORD over 100M ........................ . 10.00.. . Comfort Cooling Unit......to 3 ton/HP . .. 6.00.... .. Forms / Foundation .... . I By .. .. . Date......_.. .. to 15 ton/HP. .. .... 9.50 ...... Plumbing Ground Work _ _.. , .... ... to 30 ton/HP ...... Hough Electrical to 50 ton/HP. 17.00 . ... e - Plumbing and Heating . ..._. .. . ... .... Space Heater........ Wall Heater ....... ,. 6.00 ,,,,,,,,, I ation 8 Energy................._............ ..._.........___..... ........_....._......... Flues - other than above ........._............... _...._..........'.. 3.00.............. s--Test ........_.................._...__.. .. . ............._...........I'......_ 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 Ht9 / Coolg. Permit Fee (plus penalty P app. 0) E Final-Public Works ........................................................... Shep.t 2 CITY OF CUPERTINO BUILDING PEMUT Permit No: Address: C) L r YLE, • Date: 2 4� BUILDING PROJECT IDENTIFICATION WORKERS'COMPENSATION DECLARATION I Applicant's ,lailing Address I hereby affirm that I have a certificate of consent to self-insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof (Sec Sort Lab.CJ. Address of Building Policy No. Company STAL— Eft c,NP ❑❑ Certified copy is hereby furnished. Owner's name M ( _ QICertified copy is filed with the count, building inspection Telephone No. - departm nt r counts department. 1 Dale - Applicant � Contractor's Name �.e a Contractor's Mailing Address CERTIFICATE OF EXEMPTION FROM WORKERS' _ Lic. Na. fS"-f t3 COMPENSATION INSURANCE (This section need not be completed if the permit is for one 'Architect or Engineer hundred dollars ($100) or less.) Architect's or Engineer's Address I certify that in the performance of the work for which this permit Lic. No. is issued,I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. LICENSED CONTRACTORS DECLARATION Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of I hereby affirm that I am licensed under provisions of Chapter 9 Exemption, you should become subject to the Workers' (commencing with Section 7000) of Division 3 of the Business and Compensation provisions of the Labor Code, you must forthwith Professions Code, d my I' eme is in full force and effect. 3 c7 comply with such provisions or this permit shall be deemed revoked. License Class �� —� Lic. Number Date - - Contractor CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agencv for the Performance of the work for which this permit is issued (Sec.3097, OWNER-BUILDER DECLARATION ear Lend ' Lders Name I hereby affirm that 1 am exempt from the Contractor's License Lender's Address Law for the following reason (Sec.7031.5, Business and Professions 1 terrify that I have read this application and state that the above Code: Any city or county which requires a permit to construct,alter, information is correct. 1 agree to comply with all city and county improve,demolish,or repair any structure,prior to its issuance,also - ordinances and state laws relating to building construction, and requires the applicant for such permit to file a signed statement that herebv authorize representatives of this county to enter upon the he is licensed pursuant to the provisions of the Contractors License above-mentioned property for inspection purposes. Law(Chapter 9(commencing with Section MOO)of Division 3 of the Business and Professions Code) or that he is exempt therefrom and 9anatare of.Applicant or Agent pate the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 0 1,as owner of the property,or my employees with wages as "OWNER-BUILDER VERIFICATION their sole compensation,will do the work,and the structure is not intended or offered for sale (Sec. 7074, Business and Professions "Attention Property Owner. Code: The Contractor's License Law does not apply to an owner of ..An 'owner-builder' building permit hu been applied for In property who builds or improves thereon,and who does such work your name and bearing your signature. himself or through his own employees, provided that such - "Please complete and return this information in the envelope improvements are not intended or offered for sale.If.however,the provided at your earliest opportunity to avoid unnecessary delay building or improvement is sold within one year of completion,the do processing and issuing your building permit.No building permit owncr-builder swill have the burden of proving that he did not build will be issued until this verification is received. or improve for the purpose of sale.). I. I personally plan to provide the major labor and materials for construction of the proposed property improvement es or no 1,as owner of the property,am exclusively contracting with � P !" P pe Y P (Y ) licensed contractors to construct the project (Sec.7044,Business and Professions Code: The Contractor's License Law does not apply to 'L I (have/have not) signed an application for a an owner of property who builds or improves thereon, and who building permit for the proposed work contracts for such projects with a contractor(s) licensed pursuant to 3. I have contracted with the following person(firm) to provide the Contractor's License Law.), the proposed construction: ❑ I am exempt under See. , B.Bc P.C. for this Name rensort Address City Date Owner Phone Contractors License No. 4. 1 plan to provide portions of the work, but 1 have hired the following person to coordinate,supervise,and provide the major work- Name Address City Phone Contractors License No. 5. I will provide some of the work but I have contracted (hired) the.following persons to provide the work indicated: Name Address Phone Type of Work Signed: Property owner Socia)Security number Dste: