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10790 CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION Plans Received By ........................................... Date ........ ............... REO.: Plans.... Survey.... Cafes: Struc ..... Energy.... Elect..... Mech .... Plans Checked By ......... Date Application Approved By. Date Validated By ................r............................................. Date ..../..........`.......... Compensation Certificate Verified By ................. Date .. ......... • a W11111111 $ Permit Fee (plus penalty if applicable) ............. - ........ $........__. Plan Check Fee (fess deposit of $.......... Rct. #..........) $ ....................... Energy Plan Check Fee (Dep. of $........ Ret. #......-) $............_..-..... Strong Motion Fee ....... ........ .......... - TV Plumbing Permit Fee ................ Electrical Permit Fee ................................... .... C.1 ... $.................._... Mach. Htg./Coofg: Permit $......... 9.N. % .......... $ ... - ...... --- Residential Construction Tax ...... .................._.r- $.____.__......_. Misc. Fee ...................... .......................... -!t. .... a .... I$ ..... ------- Misc. Fee ................................................. . .... : ....... $....................... • $ ab I Environmental Status: Exempt ............ Other... ..................................... Design Review Approval: Bldg. . ........... Site ........ ... Sign Use Zone ............ P.D. Conditions ..................... Cond. Use Permit r...._.._.... Variance 4. .......... . Parking Spaces............ ApprovedBy......_ .................................. ...... - ........ Date . - - orb, Permit........................ Grant of Easement........................ orb, Gutter, Sidewalk, Driveway: Replace.......... Repair. Sewer............ Conn. Fee $ ................ Water................ Meter $................ Agreement for Completion of Public Works Improvements . Plans Checked By...._.. ... Date ........ Approved By....._. .. Date ... PERMIT INSTALLATION NO. EACH IFEE Light Outlets............ Switches............ .............................. 751-1000 Fixtures............ Receptacles............ 2001-225C 39.50 TOTAL NUMBER (less than 1000 watts) ..... .... - $ .50 - ....... Range........ Cooking Unit........ Oven ........................... 2.00 .. ........... Dryer........ Garb. Disp ..... ... Dishwasher ............. ..... 2.00 .. ........... MOTORS: 1 HP or less ............................ ........ .. , - 2.00 Interceptor........ Water Softener.. ...... ........ ....... ........ Greater than 1 HP not more than 5 HP ..... . ...... 3.50 .. ........ Temporary Power Pole or Service 100 amp . ...... .5.00 . . 200 amp ......... 7.00 . ....... ... TimeClock ........... ....... .......... ..... -- ........... .... ...... 1.50 ... . ......... Misc. (see Ord. current I ...................................................... New Residential Occupancies Flat Rate 0-500 sq. ft. $22.00 1501-1750 $34.50 501-750 24.60 1751-20000 37.50 .............................. 751-1000 26.00 2001-225C 39.50 .............................. 1001-1250 28.50 2251-2500 42.00 .............................. 1251-1500 32.00 2501-2750 49.50...... 6.6 6 .............. Interceptor........ Water Softener.. ...... ........ ....... ........ Permit Fee ...............................................$6.00 J.- ... 4.D0 . ..... ....... Misc. (See Ord. Current) .................................................... TOTAL ELECTRICAL PermitFee ............... ............ ..................... ......... TOTAL PLUMBING PERMIT FEE (plus penalty if so[). PERMIT FEE (Plus penalty if app.[]) $ Forms / Foundation ............................. By:- ...... Plumbing Ground Work...................... Rough Electrical .......... ... ..... ............. .......... .... -1---l- ...... - 0o - Plumbing and Heating .......... ,................................................., ation & Energy .............................. .. ........... ..... ................... .. . ka,um, Test ...... ....... ......... ......... .... . . . ....... Temporary Power Gas / Elect . . ........ .. ..__- ......... ....... Final - Electrical . ..................... ........... - ................. ... - Final - Building / Mechanical .............. .. ........ . . .. Final - Design Review / Landscaping Final - Public Works ........................................................... 0 PERMIT NUMBER 1 16 STREET1A3VEy,0FgJJ T: it fC �9.01'.iii .................................... Legal Description: Tra ..... - Lot-......._._.._... Description of Work: ---- ............ - ............ 1st Struct. Improvement on Parcel: Yes.... No ... Area of Bldg.._....._.... Separate Structure............ or Addition/Alteration to Exist. Bldg........... No. of Stories ................ Use of Building .... .............. .. Valuation of Arojill S ............................................... Phorl: Con raclor: nC g74 Bus. Lic. Contractor's Address: . ... .... ... Phone:G 79?< Contractor - Electrical: ... ................... .................. -- ........ ......... . ... City B U sines LiJ ire A.. ................ .. Phone:..._.._.......... Plumbing:......... . �-....... F - -- . ......... City Business License a �4!. Vl77Iahone:... Heating and Cooling ............. ........ ................._......_..-1.......... City Business License 4 .................... Phone:......._.._...... Architect/Designer:.................................. a ............... Phone:...._............... Engineer: . ................ ............................. ....... Phone:...._............_ Lender: , .. - - .... .... ... .... ... .......................... .......... .. EJ Unknown "I certify that in the performance of the work for which this permit is Issued I shall not employ any person In any manner so as to become subject to the workman's compensation laws of California." SIGNATURE OF APPILICANVOWNER .. . ......... . _ ..... . ............ .. ......... ...................... DATE......._............... "I certify that as the applicant I am licensed unde the I o the Contractors License Law and further that my Licens, Noxt7:0.7 in Classification ....................................... is in full fares and effect: or I certify that I am exempt from the "Licensed Required" provisions of the Contractors License Law. (State basis of exemption.) I hereby acknowledge that I have read this application and state that the above Is norrerl 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 against liabilities, judgments, costs and expenses which may In any way secure against said City 171coneequence I in 'I It f this a' g or perm lL" SIGNATURE, OF6qz APPLICANT/CONTRACTOR DAT, a NOTE When property a "i's 'or"i as a Building Froarnfl. This Permit expires and b can hall and .Id he not be commenced within A -oil he ' res, - . ra 120 days learn valida o date, or should authammond onstonrillon be suspended or , I"'. or 'ex war abandoned for a per] 1 110 par. after work is commenced. PERMIT INSTALLATION NO. EACH FEE Gas System with up to 5 outlets .................. -.$4.00.. ............ Each additional outlet ... - ..... ....................... ........ .. 1 .00 . .............. Water System (Installation, Alt. or Repair) ....... . ...... .. 4.00 Water Closet.... Water Freater.t.,rd. Tray ... ....... ........ 4.00 Lavatory- . Shower Pan.... Bathtub.... Sink. ....... ........ .. 3,00 - -------------- Wash. Mach..... Dishwasher.... Garb. Disp ..... ..... ........ .. 3.00 . .... ......... Sewer... ............. ................................................. ....... - 8.00 . Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00 ..................... ............. Vacuum Breakers ............................................ .. ........ .... 3.50. - .......... Interceptor........ Water Softener.. ...... ........ ....... ........ 4.00.1 ............ Plumbing Piping without fixtures ....................... ........ J.- ... 4.D0 . ..... ....... Misc. (See Ord. Current) .................................................... ............ - $ 6.00 PermitFee ............... ............ ..................... ......... TOTAL PLUMBING PERMIT FEE (plus penalty if so[). -_ ..... $ 6.Q0 1`7) 1 1 -/z, PERMIT INSTALLATION NO. EACH FEE Forced Air Unit .................. to 100M ........ - ............ ........ $ 6.00.............. . over100M ....................... - . 10.00 ............. Comfort Cooling Unit ... Ao 3 ton/HP ................. ........ .. 6.00... ...... to 15 ton/HP ....... ......... ...... - 9.50.. ............ to 30 ton/HP ................ .... .. 12.00. .: .......... to 50 ton/HP ................. ........ .. 17.00............. Space Heater........ Wall Heater ................................... 6.00 -- -- -- -- Flues - other than above . .................................... ....... 3.00 Vent Fan: Kitchen........ Bath ....................... .. ....... 3.00 Commercial Range Hood .......................................... 6.00......_....... Misc. (See Ord. Current ...................... Permit Fee ............... .................. ...... ............ - $ 6.00 TOTAL Htg./ Coo1g. Permit Fee (plus penalty if app. E)) $