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1268 CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMITAND FOR APPLICANT TO FILL IN PERMIT NUMBER CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STREETe.yF;SS OF PROJECT. _ 2.Z. �.....GAX.G.r S/....._4-T............................ DEPARTMENT • Legal Description: Tract........................ Block............ Lot...................... Description of Work: L......._............_......... PlanaReceived By....................................................Date ......................... .........................................................................................I.............................. REO.: Plans.... Survey.... Calcs: Strut..... Energy.... Elect..... Mach.... 1st Struct. Improvement on Parcel:Yes.... No...Area of Bldg............... Plans Checked By...................... .......................Date .... . ....... ,..,... Separate Structure............ or Addition/Alteration to Exist. Bldg........... Application Approved B . . X� 1.j'tl.... No. of Stories................ Use of Building ..P..ES.!:/ PP PP Y.....---' .:..4.....................Date .....ld" Validated By..............................................................Date ........................ Valuation of Project, $ ....................................... Compensation Certificate Verified By ................. Date ........................ owner:14.� L.L!4( .., .,*A4.......................... Phone:Z.J�..$. .I. Contractor: .....City Bus. Lic. a/F.:24=, 111111117T ' • • ' • ' E Contractor's Address:le.22.6r...L.Z '.'!.5.!.:...... Phone:2.244..7.2 Permit Fee (plus penalty if applicable)'-.-.::....................$....................... Contractor - Electrical: QS//Z.............................. Plan Cheek Fee (less deposit of$.......... Rct. #.......:.)$.:..................... City Business License #.................... Phone:.................... . #...._,).$ Plumbing: .................-.............................................. Energy Plan Check Fee (Dep. of $.. .::Rcl, :...................... Strong Motion Fee ..............................:::.::......... City Business License #.................... Phone:.................... Plumbing Permit Fee ......................$....................... Heating and Cooling ensefti22E................ e:.................... """""""`""... City Business License e.................... Phone:.................... Electrical Permit Fee ............................:�.....:...... $ ................ ).....1.� ....... Architect/Designer:'.................................................. Phone:.................... Mach. Htg./Coolg. Permit $...................:......... $....................... Engineer: Phone:.............. Residential Construction Tax ........................................$....................... .....__...- i..........performan................work.......w c [•1'Lfnknit 13 """"""""""""""""""""""""""""""""""" "I certify that in the performance of the work for which Ihls-permit Ie Misc. Fee ........................................................................ ....................... issued I shall not employ any person in any manner so as to become subject • $ 1A rQ to the workman's compensation laws of California." SIGNATURE OF ZONING • APPLICANT/OWNER .................___............................................... DATE...................... Environmental Status: Exempt............ Other................................... 'I certify that as the applicant I am liconsed unde' the previsions 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 force and effect: or Cond. Use Permit is............ Variance e............ 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 show Is correct and agree to comply with all City Ordinances and Slate Laws regulating • • building. I (We) agree to save, indemnify and keep harmless the City of Cupertino oachment Permit........................ Grant Of Easement........................ against liabilities, judgments,costa and expenses which may In any way Gutter, Sidewalk, Driveway: Replace.......... Repair .......... acture against said City in consequence of the granting of this permit." #we r............ Conn. Fee $................ Water................ Meter $................ SIGNATURE OF �j (� Agreement for Completion of Public Works Improvements .................. APPLICANT/CONTRACTOR ... _ .. .... TE t7.Z .T.Ic Plena Checked By........ Date........ Approved By.... Date.................... Piproperly validated this form tBuilding permit expires and becomes null and void shouldwork not be commenced within APPLICATION FOR PERMIT 120 20ndays from foa psdlati 011 0 days should fter au hs commenced.torized trction be suapendatl or PERMIT INSTALLATION NO, EACH FEE APPLICATION • , PLUMBING 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 rtlgre 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 ..................................................,............................ 8.00............... Time Clock ...................................................................... . 1.50............... Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00...................:: ............. Misc. (see Ord. current I...................................................... Vacuum Breakers ......:....:...........................:.... ..............3.50. .:.::.._._ New Residential Occupancies Flat Rate Interceptor........ Water Softener........ ........................._..4.00. ............ Plumbing Piping without fixtures ...................................4.00. ............. 0-600 aq. it. E22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) .................................................... 501-750 24.50 1751-20000 37.50.............................. Permit Fee ........... ............................................ 761-1000 26.00 2001-2250 39.50.............................. ................._ tif app. �) $ E 8.00 TOTAL PLUMBING PERMIT FEE (plus penalty 1001-1260 28.60 2251-2600 42.00.............................. 1261-1500 32.00 2501-2750 49.50.............................. APPLICATION FOR HEATING/COOLING Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.p) $ PERMIT INSTALLATION - NO.1 EACH FEE Forced Air Unit..................to 100M ............................,.E 6.00... ........... INSPECTIONs • r over loom....................... . 10.00.. ........... Comfort Cooling Unit......to 3 ton/HP ......................... ...6.00,.. •.c.Cr.V Forms / Foundation .............. .......,....._I By:........ ....... . Date:................ to 15 ton/HP........................ 9.50.............. Plumbing Ground Work . .................... y.... .......................................... to 30 ton/HP................. .12.00. Rough Electrical .......-..........................I......................... .....__.................. to 50 ton/HP........................ 17.00.. ........... e - Plumbing and Heating ..........1 Space Heater........ Wall Heater ................................. 6.00„ ........... l atlon & Energy............................... ...._...... ............................ Flues - other than above ............................................j.. 3.00.. ........... as Teat ........................................... .. ......................'.......................... Vent Fan: Kitchen........ Beth .......................................`4.. 3.00... ........... Temporary Power Oae / Elect. ........ .....:................... ........................... Commercial Range Hood 1 8.00,,..,...,,..... ..........................................`.. Final - Electrical .............................................................. ........................... Misc. (See Ord. Current................................................ ................. Final - Building/ Mechanical .........................-............ .I........................ Permit Fee ........................................................................ $ 6.00 Final - Design Review / Landscaping -..-.-.. ­-I... TOTAL Htg./ Coolg. Permit Fee (plus penalty If app, p) $/2 pC Final-Public Works ...........................................................