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17740 CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING AND CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION CITY of CUpEp11N0 SUPPLEME�J,kj JAN PERMIT Plans Received By... ................................................. Date .................... REO.; Plans.... Survey.... CaIcs: Struc ..... Energy.... Elect....- Mach.... PlansChecked By .................... - ....... ..................... Date ........................ Application Approved By ......................................... Date ........................ ValidatedBy .............................................................. Date ........................ Compensation Certificate Verified By ......... Date ......................... $ $....................... Permit Fee (plus penalty it applicable) ........................ $..2.4..60........ Plan Check Fee (less deposit of $.......... Rct. #..........) $ ................... Energy Plan Check Fee (Dep. of $........ Rct. #........) $ ................ Strong Motion Fee ....... .......... ............ I .................. $_ 6 Plumbing Permit Fee .............. ...... ...... $ Electrical Permit Fee ...................................................... $....................... Mach. Htg./Coolg. Permit $ ............................. $....................... Residential Construction Tax ........................................ $ Misc. Fee ........... __ .................. ........................ ............. City Business License #.................... Phone: .................... Misc. Fee .......... ......... - ............................. ...... $ Architect/Designer:... ...... ......... .... ............... __ ... . Phone:.................... Greater than I HP not more than 5 HP - .... __.. . 3.50 A certify that in the performance of the work for which this permit is Temporary Power Pole or Service 100 amp to theworkman's compensation laws of California." Environmental Status: Exempt ......... ... Other ........................................ 200 amp Design Review Approval: Bldg ............. Site - ......... Sign ............ Use Zone ............ P.D. Conditions ............................................................ . 1.50 ............... Cord. Use Permit #............ Variance ..... Parking Spaces............ ApprovedBy .................... ............ __ .... ....... _ ........ Date ........................... bui(dmG. New Residential Occupancies Flat Rate croachment Permit ........................ Grant of Easement........................ urb, Gutter, Sidewalk, Driveway: Replace.......... Repair... Sewer............ Conn. Fee $................ Water ..... Meter $................ Agreement for Completion of Public Works Improvements ..... - ...... Plans Checked By........ Date........ Approved By........ Date .................... PERMIT INSTALLATION NO. EACH FEE Light Outlets............ Switches............ Ave. Legal Description: Tract.. 6551 ....... Block............ Lot 4 ................. Fixtures............ Receptacles............ tat Struct. Improvement on Parcel: Yes.... No.... Area of Bldg ............... Separate Structure............ or Addition/ Alteration to Exist. Bldg........... TOTAL NUMBER (less than 1000 watts) ..... ....... $ .50 ....... Range.. Cooking Unit........ Oven............................ 2.00 .. ........... Dryer........ Garb. Disp ......... Dishwasher .. ........... ....... 2.00 .............. City Business License #.................... Phone: .................... MOTORS: 1 HP or less ........... - - ... - ........ ....... . 2.00 Architect/Designer:... ...... ......... .... ............... __ ... . Phone:.................... Greater than I HP not more than 5 HP - .... __.. . 3.50 A certify that in the performance of the work for which this permit is Temporary Power Pole or Service 100 amp to theworkman's compensation laws of California." ......... 200 amp 7.00 .............. Contractors License Law and further that my Licans, No......._........- .... Time Clock .. ...... .................. ... ....... ..... . 1.50 ............... Contractors License Law. (State basis of exemption.) Misc. (see Ord. current correct and agree to comply with all City Ordinances and State Laws regulating bui(dmG. New Residential Occupancies Flat Rate 0-500 sq. ft. $22.00 1501-1750 $34.50 .............................. 501-760 24.50 1751-20000 37.50 .............................. 751-1000 26.00 2001-2250 39.50 .............................. 1001-1250 28.50' 2251-2500 42.00 .............................. 1251-1500 32.00 2501-2750 49.50 .............................. Permit Fee ...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.0) $ Forms / Foundation .........._........._.......I By:_ - . , , ... . Date:................ Plumbing Ground Work ..................... I ... . .... . ... .... ..... . I ... - - ....... Rough Electrical ...... - .... .......... ...... )....... ....... . ... i.. _.............. ....... ,dI&ramo - Plumbing and Heating ...... I . ......... ........ .... . a its t ion & Energy ........ ....... .. ..... ....... ........ ...... ......... v. as Test ............ ___ ....... ...... ... ... . . ..... .... I Temporary Power Gas / Elect . . ........ .... ............ ...... .................... Final - Electrical ...... - ........... - ....... ......... Final - Building / Mechanical ... ................................_I......_................... Final - Design Review / Landscaping � ... . . ............. ...... .................... Final-Public Works ........................................................... PERMIT NUMBER I If T FOR APPLICANT TO FILL IN STREET ADDPff93?FJZ1FeJmECT: Ave. Legal Description: Tract.. 6551 ....... Block............ Lot 4 ................. Description of Work: ....... solar* perill --- ---- , ­ ..................................... I ................. __ ............................... 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 x..._......_...._. Phone: .................... Plumbing: ., ........ ...... ........... ...... ............... ....... City Business License #.................... Phone: .................... Heating and Cooling .... ....... - _ .... __ ..... __ ........ __ ..... - .......... City Business License # .................... Phone:.................... Architect/Designer:... ...... ......... .... ............... __ ... . Phone:.................... Engineer: ... .......... Phone:_........._....... ....... Lender: ........ ............. .. [:] Unknown A 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 theworkman's compensation laws of California." SIGNATURE OF APPLICANT/OWNER.......... _ . ..... .... ....... - ...................... __ ............. DATE........................ 'I refify that as the applicant I am licensed uhde the provisions of the Contractors License Law and further that my Licans, 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. (State 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 bui(dmG. I We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way occurs against said City in consequence of the granting of this permit." SIGNATURE OF APPLICANT/ CONTRACTOR . ...... _ ......... ....... __ ...... ___ ......... DATE .. ........ - .......... 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 from validation date, or should authorized constni be suspended or abandoned for a period of 120 days after work is commenced. APPLICATION FOR PLUMBING PERMIT PERMIT INSTALLATION NO. EACH FEE Gas System with up to 5 outlets ....................... ................ 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�1101 Interceptor........ Water Softener ........ .......... 0 Plumbing Piping without fixtures . Misc. (See Ord. Current) ....... SAI ...... . ................. ....... PermitFee ......... ................................................................ $ 6.D0 TOTAL PLUMBING PERMIT FEE (plus penalty If app. 0) $ . ocl APPLICATION FOR HEATING/COOLING PERMIT PERMIT INSTALLATION I NO. EACH I FE Forced Air Unit .................. to 100M ..................... ........ . $ 6.00 ... ............ over100M ...... __ ...... ..... _ . 10.00 ............. Comfort Cooling Unit...... to 3 ton/HP . ................ ........ . 6.00 ... ............ to 15 ton/HP ................. ....... 9.5o .. ............ �.. to 30 ton/HP ...... ..... __ . ........ 12.00 .............. to 50 ton/HP ......................... .. 17.00 .. ............ Space Heater........ Wall Heater ................................... 6.00 .. ........... Flues - other than above ... _ ............... ................ ........ 1.. 3.00.. .. ......... Vent Fan: Kitchen........ Bath ............................. . ........ -� Commercial Range Hood ... - ...... ........ - ........ _ . ...... 6':02�:: Misc. (See Ord. Current ..........................._...........1..........,....._..... j_ PermitFee ......... _ ..... __ ........ ......... ............. ................. $ 6.00 TOTAL Htg./ Coo1g. Permit Fee (plus penalty if app. 0) $