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1940 CITY OF CUPERTINO PERMIT NUMBER % 9fD APPLICATION FOR RESIDENTIAL BUILDING PERMIT AND FOR APPLICANT TO FILL IN MV, CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION D SS PA EST ,&JFSS .RFSST................._........ ,.. • . • Legal Description: Tract....b..�. p... B{pck...... ... Lot..... . ......_. Description of Work: .. 7 Plans Received By........_..............._.............._..... ., ate ......................... ...................................................................................................................... REO.: Plans.... Survey.... Calcs: Struc..... Ener _.. DOct,00. ech.... tat Struct. Improvement on Parcel: Yes.._ No... Area of Bldg............... Plans Checked By........................... �EIDeb.;.1a. Separate Structure......... . or Addition/Alteration to Exist. Bldg,.......... Application Approved By..._...__--e5! �.............. Date .1..yr!..�� No. of Stories................ Used it Ing sl�C�.4.0 .FpMA[.y .. gy Validated By................._...._.................................... Valuation o Prole t 1)✓ ............................ qq Compensation Certificate Verified By .............._.r ID................... Ow .. Al(K. .. ...._..................... Phone:Qln.C�.v�� I $ /s—���' Contractor: fw_r .ewy.._rlce"...-City Bus. ic. n .........._.. T 6� Contractor's Address* .9 N'G.HLtiliie:.,2./Ly!:7�f.. Permit Fee (plus penalty If applicable) _...........$. 7,a,._ Contractor - Electrical: ,y:j//CN..+(../�beL.f...._._........................_.. (p p y pp ) "" '"" { 00' "' City Business L'cense x. ............. Phone:2Ny-7fT Plan Check Fee (less deposit of$......... Rct. #....._..J$..,�/p....r....... Plumbing: AAt.'T. C!1!.. [...Pe?_Q. .................................j Energy Plan Check Fee (Dep. of $........ Rct. #........) $................ 0,�.. City Business License «__................ Phone.... ..'/c.�.. Strong Motion Fee ..........................................................$..i�•.. ._.. Heating and Cooling�r(/'rtEC rV. Plumbing Permit Fee $°* ` - 1�..PCOL S......._- g ............................................... Electrical Permit Fee ................._ ................ $..LL�Q_5�....... City Business License 4._....._.......... Phone:.Z. .. ... Architect/Designer:N•............ .. .. .......................... Phone:.................... Mech. Htg./Coolg. Permit $............................. $./.Qa1�. _" Engineer: Rr..KC.LO a.=.,lE .............I.......... Phone:.... Residential Construction Tax ....................._... _............$......__........_... --............. _... ...... Lender: . .. ..N at in th ... erfor........_..._......._..._........ hie EJ MISC. Fee ...........__........................................._...._...._.$. "I certify that in the performance of the work for which This permit is Misc. Fee ............................._.......................................$............_......... issued I shall not employ any person in any manner so as to become subject IINNE• $�,t--�Q`(� 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 licensed uncle the provisions of the Design Review Approval: Bldg. ............ Site .......__.. Sign ..... ..... Contractors License 4aw and further that my Licens. No. ..7.12. Use Zone P.D. Conditions in Classification .......(x.•53..__.._...., is in full force and effect: or .....Permit ........................................ces........... Cond. Use Permit •.._........ Variance *...... Parking Spaces........... I certify that I em exempt from the is of setl Required" provisions of the Approved B Date Contractors ackno t ed License Law. (Stale basis of tion anon. pP Y...__.........._.__..�.... ..._._................... ........._.........._.... I hmebY acknowledge that I have read This application and slate that the above Is rrt;ct and agree to comply with all City Ordinances and State Laws regulating • - bnild,nq r I - I (We) agree to save, indemnify and keep harmless the City of Cupertino achment Permit....................._. Grant 0f Easement.................. against liabilities, judgments, costs and expenses which may in any way „urb,'GUtter, Sidewalk, Driveway: Replace.......... Repair.......... acture against said City In consequence of the granting of this permit." Sewer............ Conn. Fee $................ Water................ Meter $.......... SIGNATURE OF � � q Agreement for Completion of Public Works Improvements ._............... APPIJCANT/CONTRACTOIO�I. 1G.Yl........ DATE 2',2.E' [. 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 not be commenced within APPLICATION FORELECTRICAL PERMIT120 days from validation date, or should authorized construction be suspended or % selabandoned for a period-1120 days after work is commenced. PERMIT INSTALLATION NO. EACH FEE APPLICATION O. 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 ............. 'I 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 . . ..... ..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 .. .O.Nd I.N fY....QN.l: ................... Vacuum Breakers ............................................ .. ............3.50.............. New Residential Occupancies Flat Rate Interceptor........ Water Softener........ .............. 4.00. ............ Plumbing Piping without fixtur s ... ..................4.00.. 0-500 sq. ft. $22.00 1501-1750 $34.50.............................. Misc. (See Ortl. Current) .. .. �t N• 501-750 24.60 1751-20000 37.50.............................. Permit Fee ..........................................................................$6.00 751-1000 26.00 2001-2250 39.50.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. ❑) t,7,S;(!v 1001-1250 28.50 2251-2500 42.00.............................. 1251-1500 32.00 2501-2750 49.50.............................. APPLICATION FOR HEATING/COOLING PERMIF Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.p) $//, 0'(J PERMIT INSTALLATION W. EACH FEE Forced Air Unit..................to 100M ...........g 8.00... .......... INSPECTION • • , over 100M ........................ . 10.00.............. Comfort Cooling Unit.....to 3 ton/HP ................-.......{., 6.00............... Forms / Foundation ............... ........... .I By:........ . ..... . Dale:................ to 15 ton/HP.... ..... 9.50.............. Plumbing Ground Work .................... I. .. ................ ........................... to 30 ton/HP............................12.00. ............ RoughElectrical ................-.................J... ..................... _._...................... to 50 ton/HP...........................17.00.. P*F -1m -.Fjambing and Heating ..........L.. ... ............._.. ........ ............. Space Heater........ Wall Heater ..............._...... ........ 6.00.............. eon S Energy..........__...._.._...... _....._...__ ... Flues - other than above ..................._.........._............L. 3.00.. ............ as ?est .........._._................... ...... ,._........._.!�L>y��.. Vent Fan: Kitchen........ Bath ................................. 3.00............... ............ ........ Temporary Power Gas / Elect. ....... ......................... ......�.................�.. Commercial Range Hood .........................................}r 8.00.....�../� inal - Electrical ....._............................ ........._.._......._. ....._.................... Mise. (See Ord. Current.......#7K.......................... L........._.....T.._.� Final - Building /Mechanical .......................................�.. .. Permit Fee ........................................................................ Final - Design Review / Landscaping . ... .......................................... TOTAL Htg./ Coolg. Permit Fee (plus penalty it app. ❑) �L1,oo, Final-Public Wor Vas ........ .. .. ........