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1293CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY 1 BUILDING INSPECTION DIVISION Plans Received By .................................................... Date ......................... APPLICATION PERMITIT INSTALLATIOO N REO.: Plans.... Survey.... Celcs: Strut..... Energy.... Elect..... Mach.... PlansChecked By .................................................... Date ......................... Application Approved By .............. ............... ........... . Date ......................... ValidatedBy.............................................................. Date ........................ Compensation Certificate Verified By ................. Date ......................... TOTAL NUMBER (less than 1000 watts) ............ . •-. $123,000 $ ,50 .• Permit Fee (plus penalty if applicable) ........................ $........321.50 Range........ Cooking Unit........ Oven ............................ Plan Check Fee (less deposit of $.......... Rct. #..........) $....................... ......... Energy Plan Check Fee (Dep. of $........ qct. #........) $....................... ..... Strong Motion Fee ...... .............. $!............8.! 1 Plumbing Permit Fee ................................................ $..........86..00 .. Electrical Permit Fee ......................._: c...l..- .......... (. r..Ste.^ $ HLt a ,.. a Mach. Htg./Coolg. Permit $............................. $ .......... �. 0 Residential Construction Tax.........:..............f............. $....................... Temporary Power Pole or Service — 100 amp ....... Misc. Fee ......... ........._................. ..._.....!':.......... _f ....... $....................... Misc. Fee........................................................................ $. ...................... . $ 504.61 TimeClock.............................................................. ......... 1.50............... ZONINGr Misc. (see Ord. current)...................................................... Environmental Status: Exempt............ Other ...... ........................... Design Review Approval: Bldg. __ ... ... Site ............ Sign ............ Use Zone ............ P.D. Conditions............................................................ D-500 sq. ft. $22.00 1501-1750 $34.50 .............................. Cond. Use Permit #............ Variance #............ Parking Spaces............ ApprovedBy ........................................................... Date ........................... roachment Permit ........................ Grant of Easement ... ..... .............. . Gutter, Sidewalk, Driveway: Replace.......... 'Repair.......... er............ Conn. Fee $................ Water................ Meter $................ Agreement for Completion of Public Works Improvements .................. Plans Checked By........ Date........ Approved By........ Date .................... M APPLICATION PERMITIT INSTALLATIOO N NO. EACH FEE , Light Outlets............ Switches ........... Fixtures............ Receptacles............ TOTAL NUMBER (less than 1000 watts) ............ $ ,50 .• ............ Range........ Cooking Unit........ Oven ............................ 2.00 .. ......... Dryer ........ Garb. Disp ...... ...Di Dishwasher ........... ..... 2.00 .. ........ MOTORS: 1 HP or less ................ .......... ...... _.... .. .. _....2.00 .. ........_.. 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)...................................................... New Residential Occupancies Flat Rate D-500 sq. ft. $22.00 1501-1750 $34.50 .............................. 601-750 24.50 1751-20000 37.60 .............................. 751-1000 26.00 2001-226C 39.50 .............................. 1001-1250 28.60 2251-2500 42.00 .............................. 1251-1600 32.00 2501-2750 49.50...........2898............ Permit Fee..............................................$6.00 TOTAIQEVCTR�QAL PERM)!_F (Plus penalty if app -13) $ 55.50 Forme / Foundation.............. ..... .. Plumbing Ground Work ......k.F.. Rough �.... ,IIIKams Eoplunnbin -and Heating ..... anon & Energy _, / Test orary Power Gas / Elect........... Final - Electrical ........ _ ......... ............ _... Final - Building / Mechanical ............... Final - Design Review / Landscaping . Final- Publ cWorks ..... ......... LIA.III 6. (•L^Bsto DOle:............. ri-(^. LG -l0-60 efk & � P 6F i YP44--i-e o PERMIT NUMBER /,Lys FOR APPLICANT TO FILL IN ST5ET ADDR SS OF PROJECT: ...d.......... Salem...Avenue................................................ Legal Description: Tract ....65.5.1 .... ..... Block............ Lot....... 3............ Description of Work: ..Single ... Family..Dwe.11ing.................. ....... _... _... _.._...'............................................-................................. .......... .... let Strutt. Improvement on Parcel: YesXx No._,Area of Bldg_.2898H Separate Structure ... .... No or Addition/ Alteration to Exist. Bldg..5.7.QG No. of Stories.. ... ..2...... Use of Building..Residential.................. Valuation of Pro act: $._123.,0..Q.O......._........._................. Owner .B.AS.,,._omes.,,..Inchone:252_2:077 Contractor: BAS..Homes ..Inc...._............ City Bus. Lia # 1.106,1. Contractor's Address2Q8f3...Stevens... Cr.k... Phone:..25.Z-.20.7 Contractor - Electrical: ..BeSt.,.6l.ectrlCal....CD......._................. City Bu6iiness Licence or 1817.2. Phone:2.$7-_2,040 Plumbing:.... TOWley„. O. City Business License *...16641... Phone:.. 245.m424 Heating and Coming ...Al_. Boyer. ..Co...... ........... :............. City B�singgs L'ynse # ... Phone:7HC.............. �ZZ-4.3 Architect/Desi her: BNSi 838-9956phon:714 7 ... .......................... er:.. cKay..4..SompS........................... Phone:..985-:65;b Lender: Wells..Fargo..Bank...................... ... ❑ Unknown nglne -. "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 APPLICANT/OWNER ............._......................................................... DATE ..................... "I certify that as the applicant i am licensed undo the provisions of the Contractors License Law and further that my Licens. No .......................... T. In Classification .._ ................................... is In full force 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 :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 Cu rt lno against liabl lltlea, judgme s, costa and ex pensee which may I fly way secure against said CIt I consequence of the granting of SIGNATURE APPLICANT/CONTRAC R DA ./....... NOTE: When proper vel doled this form eonslllutos a BullIII Permit. TSIs permit expires and becomes null and void should work not be commenced within 120 days from validation dale, or should authorized constmellon be suspended or abandoned for a period of 120 days alter work Is commenced, APPLICATION•. PLUMBING PERMIT PERMIT INSTALLATION 7NO.. EACHFEEGas System with up to 5 outlets ...................... .. $q,00 .......Each additional outlet ............................. .. .. 1.00......Water System (Installation, Alt. or Repair) ....... .. 4.00.......Water Closet4. Water Fleater.1 Ld. Trayl... 4,00.zLavatory6. Shower Pan.l. Bathtub.3. SinkA..... .. 3.00.Wash. Mac ..1. Dips washe . Garb. Disp....1...... .. 3.0D. ....9...0.0 Sewer...%t0./--,F........................1....... a.00.Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.0............... ...........Vacuum Breakers ............................................ ......3.50.............. Interceptor........ Water Softener.................................4.00............. Plumbing Piping without fixtures ................ 1 ... .....1 ... .... 4.00. ... _4...0.0 Misc. (See Ord. Current) .................................................... Permit Fee........................................................... pp TOTAL PLUMBING PERMIT FEE (plus penalty If app. [j) = 686. 00 APPLICATION•• HEATINGICOOLING PERMIT INSTALLATION IND. EACH FEE Forced Air Unit .................. to t00M ..................... .........$ 6.00..:.......... over loom ......................... 10.00 ............. Comfort Cooling Unit ...... to 3 ton/HP ................. .......... 6.00.............. 9L' to 15 ton/HP ................. ........ 0.50 ............. /gyp to 30 ton/HP................. .......... 12.00............. to 50 ton/HP ........................... 17.00............. Space Heater........ Wall Heater .................................. 6.00.............. Flues - other than above ........ I 3.00...... Vent Fan: Kitchen....l.. Bath ....ld.TyeT,i., 5„ 3.00 ... ........,... Commercial Range Hood ..... ....._....... ..._........... ......... 6.00 ... .....----.. Misc. (See Ord. Current.............................................................. ............ PermitFee........................................................................ $ 6.00 TOTAL Htg./ Coolg. Permit Fee (plusnatty if app. p) $ 33.00 IAT 7#41211 CAWDe"•f IL-tr�e•�/ IrIZAIIIACIL 5- I Iz—er�7v1,►Nua t1 ROUT' SLIP File No. Da t e �.ocat_on ... / - �o.Ics� • 1 I ApL)roved -;z , el< Date Ins_ c or CERTIFICATE OFCO COMPLETION BUILDING CITY OF CUPERTINO DATE 19 � BLDG. PERMIT NO. /THE BLDG. LOCATED AT r � OWNED BY HAS BEEN OM86EFE FOR USE AS (ALTERED) BUILDING INSPECTOR'S OFFICE Bldg. Dept. CITY OF CUPERTINO Office COPY ❑ Backflow Device Sanitary Permit No. -FI—Sewer Connection , Plumbing Permit No. i �O Plumbing Final Lot No. Owner or Tenant At Z:?, b Tract 19_Date Final q— �l' 19 / Date Connected � ll � ©M �rPLUMBI G: NSPECTOR j' C% I OFFICE CITY OF CUPERTINO COPY GAS SERVICE NOTICE ii /t/%i /(•r G� I ,19 � l To You are hereby authorized to 7 Owner or Tenant " At ) �- 6 the GAS service for s E New Service No. of Meters Reconnect Move Service I No. of Add. Meters Move Meter PLUMBING INSPECTOR r r 1 ELECTRIC SERVICE NOTICE OFFICE COPY BUILDING INSPECTOR'S NOTICE CITY OF CUPERTINO 6 19 To You are hereby authorized to Connect electrical service for OwnerorTenant - - Ecr '- At No. of Wires Size of Wires Size of Switch Motor Load Voltage Phase Heoting load - K. W. Voltage i / (1 Light lli).New Service Reconnect No. of Meters Heat 120_Three Wire More Service No. of Add. Meters Power .' \ Three Phase Move Meter ©" ELECTRICAL INSPECTOR