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1773• CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING • AND CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION SUPPLEMENTAL)NO • JAN • ^ 1CIR1 PERMIT Plans Received By ..................................... - ...... ...... Date ........................ REQ.: Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach.... PlansChecked By ...................... -........................... Date ......................... Application Approved By ......................................... Date ........................ ValidatedBy.. .............................. .............. _ ........ .... Date ........................ Compensation Certificate Verified By ............. ... . Date ......................... Permit Fee (plus penalty if applicable) ........................ $_2k.0.0 .... Plan Check Fee (less deposit of $.......... Rot. #..........) $....................... Energy Plan Check Fee (Dep. of $........ Rct. #........) $......... .. Strong Motion Fee .......................................................... $....la:.: ;,6 Plumbing Permit Fee ............ ........... .................... $..........'........... Electrical Permit Fee ...................................................... $...r1 .... Mach. Htg./Coolg. Permit $............................. $....................... Residential Construction Tax ........................................ $....................... ' Misc. Fee ... ........ ...... ___ ... ........ -...... ......... ........ ........... $....................... Misc. Fee........................................................................ $.................... -. • $ w4 sn • r Environmental Status: Exempt ............ Other ........................................ _ Design Review Approval: Bldg ....... _... Site ............ Sign ...._...... Use Zone ............ P.D. Conditions .................... ...... ......... ____ .......... ..... Cond. Use Permit #............ Variance #...... ..... Parking Spaces............ ApprovedBy... ..... .................................................. Date ........................... •• r ncroachment Permit_ ................. ... Grant of Easement........................ New Residential Occupancies Flat Rate urb, Gutter, Sidewalk, Driveway: Replace.......... Repair....... ­ ..Sewer............ Sower ............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............ Fixtures.-.......... Receptacles............ 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 _............ Greater than 1 HP not more than 5 HP ............... 3.50 .............. Temporary Power Pole or Service — 100 amp ..........5.00 _ -.... ..... —200 amp....... 7.00 .............. Time Clock . .......... ........ _....... _..... 1.50............... Misc. ( see Ord. current)....................:................................. New Residential Occupancies Flat Rate 0-500 sq. ft. $22.00 1501-1750 $34.50 .............................. 501-750 24.50 1751-20000 37.50 .............................. 751-1000 26.00 2001-225C 39.60 .............................. 1001-1250 25.50 2251-2500 42.00 .............................. 1251-150032.00 2501-2750 49.50 .............................. ' Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.p) $ Forms / Foundation .......................... Plumbing Ground Work ..................... Rough Electrical ............ _........ ........ .... rame - Plumbing and Heating ......... sulation & Energy ..................... asTest - ... ..._............ ._......._...... -. Temporary Power Gas / Elect......... Final - Electrical ..... ........ - ..... ........ .... Final - Building / Mechanical ............. Final - Design Review / Landscaping Final -Public Works .................... By: ........ ..... J. Date:................ PERMIT NUMBER % % FOR APPLICANT TO FILL IN STREET ADRS OF PROJECT: _22 6 25 Salern-Ave.............. _......_........ ................................. Legal Description: Tract. _ -.6551- - Block............ Lot ...... .3 ----------- Description of Work: ......... sal..... ... ermi......................................... tat 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 Project: $. .... _ ....... _....___ _... ___ ........................ ........... Owner: .... -...... ._.............. ...... . _..... ...._............ ...... Phone:.................... Contractor:...... BAS -HOMES, -INC:. --...City Bus. Lic. # .............. Contractor's Address: ...... . ............ ...... Phone:.................... Contractor - Electrical: ..,. . ..... _........ _..................... City Business License #................. Phone:.................... Plumbing: ............ - ..... _ ___ ...................... ............... City Business License #. ................... Phone:.................... Heating and Cooling .. ... -.......... ..... .........__...._.....-.....__._... City Business License #.................... Phone:.................... Architect/ Designer: ........__...._............_............ .... . Phone: ... __ ----- ...... Engineer: . . ....... .... .......... ...... __ ... ..... - ... Phone:.................... Lender: . .. ........ ...... ................ _ .... ........... __ ❑ Unknown .. .. ... "I certify that in the performance of the work for which this permit Ia 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 rortily that as the applicant I am licensed unde the provisions of the Contractors License Law and further that my Licens. No. .............. ,_........... in Classification ...... _........... ............ _..... is in full force and effect: or ..... .. I certify that I am exempt from the "Licensed Required" provisions of the Convactors License Law. (State basis of exemption.) I hereby acknowledge that I have read this application and state that the above is :orrecl and agree to comply with all City Ordinances and State Laws regulating building. I (We) agree to save, Indemnity and keep harmless the City of Cupertino against liabilities, judgments, costs and expanses which may In any way acture against said City In consequence of the granting of this permit." SIGNATURE. OF APPLICANT/ CONTRACTOR ........................... .................... ........ _ 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 120 days from validation date, or should aulhorixed construction be suspended or abandoned for a period of 120 days after work Is commenced. APPLICATIONr. PLUMBING PERMIT 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 Heater.... Ld. 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. $2.00 ..................... ............. Vacuum Breakers ............................................ .3.50.. Interceptor........ Water Softener..-..... - ..........................4.00............. Plumbing Piping without fixtures ...................................4.00, ,.,,, Misc. (See Ord. Current) ... solar...per2Li ....... A..O .......... PermitFee..........................................................................$ 6.00 TOTAL PLUMBING PERMIT FEE (plus penalty if app, p) $ 10.00 APPLICATION••HEATING/COOLING PERMIT INSTALLATION I NO. EACH FEE Forced Air Unit ................. to 100M ..................... .........$ 6.00............... over10010 ......................... 10.00 .. ........... Comfort Cooling Unit......to 3 ton/HP ................. .......... 6.00............... to 15 ton/HP ......................... 6.50 .............. to30 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........ Bath ......................................... 3.00............... Commercial Range Hood ................................... ... 8.00,__ Misc. (See Ord. Current .... ............ _....._.................._.................. ...... ..._. Permit Fee ...... ............ .................. .................. $ 8.00 TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. p) E