1434 • • -9
CITY OF CUPERTINO
APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER
AND
. . APPLICANT TO FILL IN
CERTIFICATE OF OCCUPANCY
BUILDING INSPECTION DIVISION STREET DR SOF PROJE T:
/b. .... ...aPn.y.. RY........................_............................
s • . , Legal Description: ........ Block.........,. Lot......................
Descriptionof Work: .ll('.Lfi.SE.A.....Agr4o..........................
Plans Received By................ . . .. .............Data ...cl...3?f .... ................................�.�/':K.r.Z$.!...... .....
REO.: Plans.... Survey.... Celts: Strut._.. Energy.... Elec ..... Mach.... let Struct. Improvement on Parcel: Yes.... No... Area of Bldg...............
Plans Checked By....................................................Date ......................... Separate Structure............ or45a—di6`o.3V Alteration to Exist. Bldg...........
Application Approved By.........................................Date .............-.......... No. of Stories................ Use of ulld'inng .................................................
Validated By..............................................................Date ........................ Valuation of toted r: $.. U .............................. r1
Compensation Certificate Verified By ................. Date ...................... Owner: ._. :....N..... x�q .�......I........-. Phone:.a[J�..'r -.. 37
Contractor:.No, fir1 ......City Bus. Lic. #/'J$�(v
• • • ' • $ Contractor's Address:63ti...J2EEi)..,57"........ Phone:.ZiZ7.c� 3U 3
Permit Fee (plus penalty if applicable) �-' Contractor - Electrical: ................................._..._........................_............
P e PP 1 ..Fict..4...........$..a.......�' City Business License #.......... Phone:...................
Plan Check Fee (less deposit of$.......... Rct. #..........)$.'��....:...
Plumbing: ......................................................................................
Energy Plan Check Fee (Dep. of $........ Ret. #..-..-..)$..................2. City Business License 0.................... Phone:.........
Strong Motion Fee .........................................-..............$...........f.. ...... Heating and Cooling
.......... .....................................................
Plumbing Permit Fee ................................................ #....................... City Business License #.................... Phone:....................
Electrical Permit Fee ....................................--.....-....-$....................... Architect/Designer: .. ...........
Mach. Htg./Coolg. Permit $............................. $....................... ......... Phone:....................
Residential Construction Tax ........................... Engineer: ... . . ........__........................._..............
Phone:.._................
.............$...................... �. . .... . ... � Unknown
Mise. Fee .............................._.............................—........$........ .....". LendefI certify that in the "performance of the work lot which this permit la
Misc. Fee ............................ ........................ $.....�oo.......
�•r—.....� issued I shall not employ any person in any manner so as to become subject
• $'17 , �T V 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 unde the pro ions of the.
Design Review Approval: Bldg. ._......... Site ............ Sign ............ Contractors License LaXiand further that my Licens. No. L2.Q3—q
Use Zone P.D. Conditions in Classification ..... .L7_....... ._........, is in full force and effect: or
Cond. Use Permit #............ Variance #............ Parking Spaces....... I certify that I am exempt from the "Licensed Required" provisions of the
Approved By........ Date Contractors License Law. (State basis of exemption.)
- - ---'"-"'""'" ""-'^^"""""""' I hereby acknowledge that I have read this application and state that the above Is
_ corrnct 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
croachment 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."
.war............ Conn. Fee $...........-... Water................ Meter $................ SIGNATURE OF /j '
Agreement for Completion of Public Works Improvements .................. APPLICANT/CONTRACTOR .L:'Irs+ .. . ._.__..... DATE 7..�3D.:-.....
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 •• ELECTRICAL PERMIT 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 APPLICATION 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. DIED......... 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 Ortl. current I...............,..,................................... Vacuum Breakers ......_.................................... ...3.50..
New .side nilel Occupancies Flet Rete Interceptor........ Water Softener........ .............................4.00. ............
Plumbing Piping without fixtures ...................................4.00-..............
0-600 sq. /t. $22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) ....................................................
501-750 24.60 1751-20000 37.50..............................
761-1000 26.00 2001-225C 39.50.............................. Permit Fee .....................F ... . .n ..... 6.00
.........$ 8.00
1001-1250 28.60 2251-2500 42.00..............................
TOTAL PLUMBING PERMIT FEE (plus penalty it app. 11) $
1251-1500 32.00 2501-2750 49.50.............................. APPLICATION FOR HEATING/COOLING
PermitFee...............................................$6.00
TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.0) $ PERMIT INSTALLATION I NO. EACH I FEE
Forced Air Unit..................to 100M ..............................$6.00...............
INSPECTION ! • r over 100M .......................... 10.00.. ...........
Comfort Cooling _
. /HP
Unit.....-to 3 ton ........................... 6.00,.. ........_..
Forms / Foundation ............... ...... ......� By:.. ..... . ..... . Date:............... to 15 ton/HP.................. 9.50....
Plumbing Ground Work ................ .........I...............
to 30 ton/HP......................... ..12.00. ............
Rough Electrical ................acing ..........�. ................... .......................... to 50 ton/HP......................... 17.00..............
rams - Plumbing and Heating ..........1........................ ........................... . f 6.00..............
Space Heater........ Wall Heater ..................................
ulatlon & Energy............... ........... ... ...........
f .. .......�........... ............... Flues - other than above .............................................�.. 3.00..............
s Test . .......... 3.00...............
l ........._._.........._...lee ._.... ... .. .._... .......... .......................... Vent Fan: Kitchen........ Bath ..._.........................
emporary Power Gas / Elect. ........ .............._.._... 6.00
-- �'-�"--�'------- Commercial Range Hood
Final - Electrical ...................... ._....._........_......-.._... ..................... ... Misc. (See Ord. Current...........---..............._....................................
....
Final - Building/Mechanical __-......................._._..................__.._--- Permit Fee ......................_...........................--............. $ 6.00
` Final - Design Review / Landscaping . ._ ......_. ._...... .... TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. (]) $
6f[L Final- Public Works ...........................................................