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1620 CITY OF CUPERTINO 086167 APPLICATION FOR RESIDENTIAL BUILDING PERMIT ,, J D PERMIT NUMBER �o oZ O _ - AND L!Y>Le FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STREET ADDRESS 9F PROJECT ElffmanummErwo Legal Description Tract+ .... . BlockT .... . Lot .. ... ... Description of Work j p. OF_ F[7jLL„ Plana Received By__...__.........-............................Date .. .............. REO.: Plans.... Survey.... Cafes: Struc..... Energy.... Elect..... Mach.... ist Struct. Improvement on Parcel: Yes.... No.... Area of Bldg............... Plans Checked By ................ . Date ..__....._. ..4 Separate Structure............ or Addition/Alteration to Exist. Bldg........... Application Approved By. -. .. ... Data I .. ... No. of Stories Us qj building .. . - ...._ .._._ Validated By_.... .... -- ...........--.. Date ------.... .. Valuation of role $... .. . � Compensation Certificate Verified By ' ..-- -._- Date ._.. ... Owner.... x... Phone:`(✓ I ,,// G� Contractor. -City Bus Lc # eye • • • • ' S T, o Contractor ass ._ Pone �aJ Permit Fee (plus penalty if applicable) ... ....$ -3'Z �_ _ Contractor - Electrical: ... ........_ ... Plan Check Fee (less deposit of$-........ Rct. #.... $. City Business License # ....._._....... Phone-.. -............ Energy Plan Check Fee (Dep. of $ .... Rct. # ...)$ - _ ... Plumbing: ....._-- . ........... --.-. City Business License # ..... Phone Strong Motion Fee . .....__.._... .... .... .....$ - _-A .._ ... Heating and Cooling ..._....... . - . _.... . ....... Plumbing Permit Fee ................._.................._....__$...................... City Business License #............... .... Phone:.................... Electrical Permit Fee ............ - -- - _..1$-- ....-... Mach. Htg./COOIg. Permit $ $_ - ..______ Architect/Designer: ..._.... ............._... _.... Phone:........_...._... " ...................... Engineer: . -. . ..... . ..._. ....... Phone'........ Residential Construction Tax ....-. - -_-$-- ._ ... -- -- _.. Lender: .... ... .._..._ . ... _.._ Unknown Mises Fee ... ...._. ..__._.. .....$ ._ .. ^I certifythat In the Misc. Fee ... ...._-. ............ _._$ performance of the work for which this permit le ••�� r --- issued shall not compensation any parson f any manner so as to become subject • $max� �O to the workman's tom ensatlon laws o/California-" , SIGNATURE OF ZONING • APPLICANT/OWNER .........................._....._..........._............._......_.. DATE........................ Environmental Status: Exempt ........... Other_ .............. ........ "I certify that as the applicant I am licensed undethe provisions of the Design Review Approval: Bldg. Site .- Sign ..__ ... Contractors Lic Law and unhe tat my Licens. No --- ......_ Use Zone ... ._.. P.D. Conditions in Classificatio r�0..T0 / in lull force and effect: or Cond. Use Permit #....._..... Variance i.... Parking,Spaces__.._.._ -- certify that I am exempt from the 'Licensed Required" provisions of the Contractors License Lew. (State basis o/ exemption.) Approved By._..................____. .___............. Date ___..................... I hereby acknowledge that I have reed this application and state that the above Is :orrect and agree to comply with all City Ordinances and State Laws regulating • • building. I (We) agree to save, Indemnify and keep harmless the City of Cupertino PI `roachment Permit........................ Grant of Easement _---.... against liabilities, judgments, costs and expenses which may In any way ,_rb, Gutter, Sidewalk Driveway: Replace......_-. Repair_.__. acture against said City In consequence of the granting of this permit.'' Sewer ....... Conn Fee$.... _.._ Water _._ Meter $ _.-... SIGNATURF OF Agreement for Completion of Public Works Improvements .... .. APPLICANT/CONTRACTOR Plans Checked By ._Date......- Approved By ..... Date ._ ... NOTE: When properly validated this corm ooruswtea a Bull a. This Permit expires and becomes null sad veld should work not,be cemm•nced within APPLICATION • 140 days from validation date, or should authorized con•trocaon be susp•ndi or abandoned for a period of 120 days after work is commenced. PERMIT INSTALLATION NO. EACH FEE PLUMBINGAPPLICATION FOR 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 -Greater than 1 HP not more than 5 His ........___ 3.50 ......--- Lavatory- Shower Pan._ Bathtub.... Sink......_. .......... 3.00. ............. Temporary Power Pole or Service — 100 amp .._... 5.00 _... .... Wash. Mach..... Dishwasher...- Garb. Dap..... ............... 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............... 0-500 sq. ft. $22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) .......... 501-750 24.60 1751-20000 37.50.............................. ..............------ ............6.00 .... 751-1000 26.00 2001-2250 39.50.............................. Permit Fee ........... MIT -. .. us Remit..-._._...._...-...$ 8.00 1001-1250 28.50 2261-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty I} app. Q) $ 1251-1500 32.00 2501-2750 49.50.............................. APPLICATION PermitFee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.p) $ PERMIT INSTALLATION Ill. EACH FEE Forced Air Unit.,...............to 100M ....._.._.................. .$6.00... .......---. INSPECTION • . over 100M _ ......... .._... . 10.00.. ........... Forme / Foundation ..... By ... . Date Comfort Cooling Unit_._to 3 ton/HP _ .. 6.00 - .--- to 15 ton/HP .. . 9.50 Plumbing Ground Work ..... 1..... ... ._ _. to 30 ton/HP _ _. . 12.00 Rough Electrical _. . f-.... ... _ ._. to 50 ton/HP . -.... ....17.00.. ......... e - Plumbing and Heating _.. _. __ .. 6.00 iatlon & Ener ._. Space Heater... Wall Heater r 9Y - ---, -- - Flues - other than above 300 das•'Test .. -�- -�� - � Vent Fan: Kitchen .. Bath 3.00 Temporary Power Gas/Elect ... _. __ .. 6.00 _ Final - Electrical ___ Commercial Range Hood ... . ....- Final Building / Mechanical - -." Mist. (See Ord. Current.. ...... __. . .. �� .......- Permit Fee ...... _ .__�� .. $ 6.00 Final Design Review I Landscaping ... .... --- -_. .. TOTAL Htg./ Coolg Permit Fee (plus penalty if app ❑) $ Final- Public Works ...............................................4........... -