1294CITY OF CUPERTINO
APPLICATION FOR RESIDENTIAL BUILDING PERMIT
AND
EACH
CERTIFICATE OF OCCUPANCY
Light Outlets....:.::.:. Switches............
BUILDING INSPECTION DIVISION
751-1000
DEPARTMENT USE ONLY
2001-225C
Plane Received BY .................................................... Date .........................
TOTAL NUMBER (less than 1000 watts) ............
REO.: Plane.... Survey.... Calcs: Struc..... Energy.... Elect.....
Mach....
Plana Checked By .................................................... Date ....----...............
2.00 ..............
Application Approved By .................................-...... Date .................
--....
ValidatedBY ................... ..... -................................... Date - .......
..............
Compensation Certificate Verified By ................. Date .........................
2.00 -.............
• • • $ 129,000
Greater than 1 HP not more than 5 HP .- ... ...... ..
Permit Fee (plus penalty if applicable) .....................- $......33.0...50.
Plan Check Fee (less deposit of $.......... Act. #..........) $.......................
..............
Energy Plan Check Fee (Dep. of $........ Act. $.......................
— 200 amp .........
_#........)
-- r
Strong Motion Fee ..................._.....::...........:.:..:. ..... :... $................3.
Y1
Plumbing Permit Fee ...................... .....................$.........8.6...00.
1.50...............
Electrical Permit Fee ._ ...............:n: .:.^..r.?. r..?".:..: :.... $.........55.,.50.
Misc. (see Ord. current)......................................................
Mach. Htg./Cool9• Permit $..,, hll/U•:!,!;..!........ $.....
_._.33.•.0.0.
Residential Construction Tax ........................................ $ .......................
Misc. Fee .................................................'...... ......:........ $ .................
..
...........
Misc. Fee ........................................................ --............. $.......................
. $
514.03
Environmental Status: Exempt ........... Other ... ......... _......................
...
Design Review Approval: Bldg ............. Site ............ Sign ............
Use Zone ............ P.D. Conditions ... --........... --.......... ..........
--- ............
Cond. Use Permit ♦.... ........ Variance •............ Perking 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... ...... ..........
PERMIT INSTALLATION NO.
EACH
IFEE
Light Outlets....:.::.:. Switches............
751-1000
Fixtures............ Receptacles............
2001-225C
39.50 ..............................
TOTAL NUMBER (less than 1000 watts) ............
$ ,50 ..
............
Range........ Cooking Unit........ Oven, ........... ...... .. ....
2.00 ..............
Dryer........ Garb. Disp......... Dishwasher ...................
2.00 ..............
2501-2750
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
..............
PERITNJ EE Piue penalty it epp.0) $ 55.50
— 200 amp .........
7.00 ...............
Y1
TimeClock ............................... --. .................. --- ........
1.50...............
Misc. (see Ord. current)......................................................
New Residential Occupancies Flat Rate
0-600 sq. ft. $22.00 1601-1750 $34.60
501-750
24.60
1751-20000
37.60 ..............................
751-1000
26.00
2001-225C
39.50 ..............................
1001-1250
28.50
2261-2500
42.00 ..............................
1251-1500
32.00
2501-2750
49.50.........3030
.............
Permit Fee...............................................$6.00
TOTAI. ELECTRICAL
PERITNJ EE Piue penalty it epp.0) $ 55.50
Y1
INSPECTION.•.
Forme / Foundation ...........
Plumbing Gro
yLd Work
..
...........
By,�.... _.
jp......_......./O.�O'..In.....
Datp:..�
Rough ec rical ... ... • ...i�a. (... ...1
AII&a umbi 19 end H In .........T.........
M11 :tion & nerg .....,
Test............. ..................... .... ..�_.....
porary Power Gas / Elect....
Final - Electrical
Final - Building / Mechanical .....................
Final - Design Review / Landscaping ....... .
Final- Publicgrka ... ......
Let.)BrL lVT69. �',L . e .........
uPPEn. �(y • 4 3-40 �a
Lw.py�• �1 �-1.p�-$a
.................. .
PZ* -AJ
PERMIT NUMBER
EE��
FOR
APPLICANT TO FILL IN
OF PROJECT:
STFjF.o1..bD ...Salem -Avenue... ....................................................
LegalDescription: Tract .... -.65.5.1..... Block............ Lot...... 4 ..............
Description of work: Single..Family... Dwelling ...................
.....- ........................-.....................................................................................
tat Struct. Improvement on Parcel: YeSX. No.... Area of BIdg.303.0kI
Separate Structure..... No.. or Addition/Alteration to Exist. BldgO.3.9.G
No. of Stories ..... .2........ Use of Building .._..Residential ..............
Valuation of Pro'ect: $.129, 000..... ......... ..................................
.............
Owner: .BAS..(�Omes.,.,-1nC ................. ..........._. Phone:.Z5.2-.Z0.77
Contractor: BAS...HOmes.,...lnc............. ._City Bus. Lic. e
Contractor's Address: ..20823..Stevens ... Crk Phone:.252-2.0:7.7
Contractor - Electrical:.. The ... Best -Electrical ... CO ...... .......
City Business License «..1817.2..... Phone:.28.7-.2.040
Plumbing: ...GTo.Wley... CO., .... ..-...........................................
City Business License •..1664.1..... Phone:.2.454.24.0
Heating and Cooling .... Al .... Boyer ...Co ................................
City Business License #.................... Phone:...7.9.2-.432
Architect/Designer: SwallO%VBates..838-995&hone7.14-752-.8
Engineer: Mc%. ... Fr...SOmps....__........................ Phone:.985-.0960
Lender:... Wells_ Fargo ... Bank ....... - ......... ......... .. ❑ Unknown
"I certify that in the performance of the work for which this permit to
issued I shell 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 uncle 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
Contractors License Law. (Slate basis of exemption.)
I hereby acknowledge that I have read this application and state that the above Is
correct 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 Cup Lino
against liebl lit ies, ludgm nta. costa and expenses which may in ny y
acture against asid C y m consequence of the granting oft r .'
SIGNATURE. OF 'y/ t1�.�,�,,, •�{
APPLICANT/CONTRA O
NOTE: When property validated this form constitutes a Building Permit. This
permit expires and becomes null and void should work not be commenced within
120 days train validation data, or should authorized construction be suspended or
abandoned for a period of 120 days alter work Is commenced.
APPLICATIONe• PLUMBING
PERMIT INSTALLATION NO. EACH FEE
Gas System with up to 5 outlets ..............1..........1....$4.00..........0.0
Each additional outlet ............................................. 1.00...............
Water System (Installation, Alt. or Repalr)l...... .... 1.... 4.00. ..... .4.,.00
Water Closet.4 Water Heaterl. Ld. Tray..1...... .... 6.... 4.00...2.4...00
Lavatory.6 Shower Pan..l Bathtub..3 Sink..l.....11-.. 3.00....33...00
Wash. Macp... Dishwas er.l Garb. Disp..... 1 .... ... .3.. .. 3.00. ..... 9.,0.0
Sewer ...LQ ./9...AO...........................1........1.... 8.00. ..... .8.,.0.0
Lawn Sprinkler Sys. $5.00 Ea. add Sys.$2.00..................................
Vacuum Breakers ............................................ ..............3.50..............
Interceptor........ Water Softener.....................................4.00.............
Plumbing Piping without fixtures ....... ..........1........1......4.00.,.,,_4...0.0
Misc. (See Ord. Current) ....................................................
Permitfee..........................................................................$8.00
TOTAL PLUMBING PERMIT FEE (plus penalty if app. _j) _ $6.00
APPLICATION ••HEATING/COOLING PERMIF
PERMIT INSTALLATION I NO. 1111 IFEE
Forced Air Unit .................. to 100M ........................2...$ 6.0o...
overIOOM ....................... . 10.00....... ......
Comfort Cooling Unit ...... to 3 ton/HP ........................... 6.o0... ............
to 15 ton/HP......................... 9.50..............
to 30 ton/HP .......................... 12.00 .............
to 50 ton/HP........................... 17.00.............
Space Heater........ Wall Heater .......................... ....... 9.00..............
Flues - other than above ........................ .............. .......�.. 3.00 .. ............
Vent Fan: Kitchen..l... Bath 3.../..Dryer... 1........5..`4.. 3.00....15..0.0
Commercial Range Hood..........................................1.. 6.00...............
Misc. (See Ord. Current...........................................................................
PermitFee .............. ............... .... --.................. --............ $ 6.00
TOTAL Htg./ Coolg. Permit Fee (plus penalty r app. ❑) $ 33.00
CAUT VA Upreft e. Mill*
ciAR.SPa.G- �0•l—$0� ti�a.,,,., cL w •'u.�l.:.,,w�t�tga Fi�AnL�.I-u'8idla
R61JTE SLI?
File No.,
/) Date
r
F
Sv.^;;ect
Notes
Approved
Date Ir.s_ c•.or
CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
�`- DATE , 19' BLDG. PERMIT NO.
L L 1A, 6W
'g THE BLDG. LOCATED AT
'OWNED BY- J3hr i;' //!J✓�-'^->j �,lJC.' -
HAS BEEN OMPLET FOR USE AS
(ALTERED)
ELECTRIC SERVICE NOTICE OFFICE COPY
BUILDING INSPECTOR'S NOTICE
CITY OF CUPERTINO
19
To
You are hereby authorized to Connect electrical service for
Owner or Tenant 64—c' � �}j t
At
t No. of Wires Size of Wires Size of Switch
I Motor Load Voltage
Heating Load K. W. Voltage
/ Light 110 New Service r Reconnect
4 No. of Meters Hem I20_Three Wire More Service
No. of Add. Meters Power Three.Phose Move Meter
� O• ELECTRICAL INSPECTOR
OFFICE
cr CITY OF CUPERTINO COPY
/ GAS SERVICE NOTICE
n 19,4i
i
To
You are hereby authorized to connect the GAS service for
Oo
At
New Service
No. of of Meters Reconnect
No. of Add. Meters Move Service
Move Meter
PLUMBING INSPECTOR
BUILDING INSPECTOR'S OFFICE Bldg, Dept.
CITY OF CUPERTINO Office Copy
❑ Backflow Device Sanitary Permit No.
NO Sewer Connection Plumbing Permit No.
�Z Plumbing Final Lot No. ?
t
Owner or Tenant �� 5 / fcn P" r i o--
At2:10C 5ALFf XJi�-
Tract
Date Connected /L/ —1920—Date Final 190
p `
PLUMBING INSPECTOR