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1300 CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER /�p O AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STREET ADDRESS OF PROJECT: -........./oLal.......An.thony.Place.......................................... Legal Description: Tract.....6551......- Block............ Lot......1.0........... D a a c r I pt I on of work:........ S in g le...F a m i I y_0 W e 1.1 i n g............. Plans Received By............ ......................Date .. ... .. ................. REO.: Plans.... Sl 6ijtlf;A/� : rue..... Energy.... Elecft..... Mach.... tat Struct. Improvement on Parcel: YesX. No... Area of Bldg..31231i Plans Chocked By..............0.. .. .............. Date �4 ;V Z...... Separate Structure.....NO, or Addition/Alteration to Exist. Bid .5.8.213 Application Approved By.............. Date No. of Stories-__....2..... Use of Building . Re,51d,ential................ Validated By.................................... ....... Da:: :.. . ... Valuation of Project $.132,.000........._..._........._.... --_--------------- Compensation Certificate Verified By ...W/17" DaOwner: . BAS..Homes,..JnC......... Phone:.252nnr ContractorBAS Hornel . _W. ...... -.-.-.-.City Bus. Lic. # MIIIIII $ 132,000 C ...$_teven.9,,.Cr1 fi09. 677 Permit Fee (plus penalty if applicable) ...................... $......335-00t Contractor - Electrical: .. The...Best...Electrical...Co_.......... Plan Check Fee (less deposit of$.......... Act. #.......... $....................... City Business License *.....1817.2.. Phone:.28.7�20.40 Energy Plan Check Fee (Dep. of $........ Act. #........ $....................... Plumbing: ......Cro.W.1ey_CO Strong Motion Fee ....................................... $�...........9_24. City Business License x..1664.1.....' P_hone:.2_45.:nA'Z40 Plumbing Permit Fee .......... .......... ................. Heating and Cooling Al...B.oyer...Co...............__............... s.........85-00. City Business License #---__ Phone:.792-.432E Electrical Permit Fee ......................... $.........55.x.5(} Architect/DesignerSwalloWBates.838-.995.6 Phone7 14---75,2�8)24 Mech. Htg./Coolg. Permit ...... $.........30.•.00 Engineer: McKaf.4-SOMPS.-... ... -........... Phone:.9.85mO.9.60 Residential Construction Tax ........................................$....................... Lender: .. . We Is..Fargo..Bank- .. ____ C] Unknown Misc. Fee ............ ..............1..... ...............................$....................... "I certify that in the performance of the work for which this permit is Misc. Fee ......................................................................$....................... issued I shall not employ any person in any manner so as to become subject • $ 514.74 to the workman's compensation laws of California." SIGNATURE OF ZONING REQUIREMENTS APPLICANT/OWNER .......... ......._.............. DATE........................ Environmental Status: Exempt............ Other........................................ "I certify that as the applicant I am licensed unde- the provisions of the Design Review Approval: Bldg. ............ Site ............ Sign ............ Contractors License Law and further that my Licens, No. ­................. Use Zone ..... P.D. Conditions ............................................................ in Classification is in full force and effect: or I I Cond. Use Permit •............ Variance •............ Parking Spaces............ certify that am exempt from the "Licensed Required" provisions of the Approved By.......__.............i.................................. Date ........................... Contractors License Law. (State basis of exemption.) I hereby acknowledge that I have read this application and state that the above Is cormcl and agree to comply with all City Ordinances and State Laws regulating PUBLIC WORKS REQUIREMENTS building, I (We) agree to save, indemnify and keep harmless the City of Cupertino incroachment Permit........................ Grant of Easement........................ against liabilities judgments costs and expanses which may in y way b Gutt I Is r, Sidewalk, Driveway: Replace.......... Repair.......... secure against said C1,t,Alinsecuence of the granting of I Ir. at.... Conn. Fee $................ Water................ Meter .................. SIGNATURE OF %re'ement for Completion of Public Works Improvements .................. APPLICANT/CONTRALTO Plans Checked By........ Date........ Approved By........ Date.................... NOTE: When properly validated he form constitutes a Building Permit. This permit expires and becomes null and void should work not be commenced within APPLICATION FOR ELECTRICAL PERMIT 120 days from validation date, or should authorized construction be suspended or I- abandoned for a period of 120 days after work Is commenced. PERMIT INSTALLATION NO. EACH FEE APPLICATION FOR PLUMBING PERMIT Light Outlets............ Switches.......... . Fixtures............ Receptacles............ PERMIT INSTALLATION NO. EACH I FIE TOTAL NUMBER (loss than 1000 watts) $ .50 .. ............ Gas System with up to 5 outlets 0 .........1...............1...$4.0ru . n • Range........ Cooking Unit........ Oven............ ......... ...... 2.00 .............. Each additional outlet ............................................. 1.00. ............. Dryer........ Garb. Disp......... Dishwasher ............. ...... 2.00 .. ............ . Water System (Installation, Alt. or Repair) 4.00. .....4.,..00 MOTORS: 1 HP or less ...................................... - 2.00Water Closet3. Water Freaterl Lot. Tray.....1...1... ... 4.00. 20J0 Greater than 1 HP not more than 5 HP .............. . 3.50 .............. Lavatory.5 Shower Pan2.. Bathtub..2 Sink...J.... R,' .1a... 3.00....30._00 Kr Temporary Power Pole or Service 100 amp ..5.00 .......... \� Wash. Mach.l... Dis washpLij.tarb. DISID...1 3_ 3.00. ..... 200 amp.. ....... 7.00 .............. Sew F.._'.....................1.......1. 8.00. ......8.-1]0 Time Clock .......... ................................................ ........ 1.60............... Lawn Sprinkle Sys. $5.00 Ea. add eye. $2.00 .................... ............. Misc. (see Ord. current) Vacuum Breakers ............................................ .. ...........3.50. ............ Interceptor........ Water Softener........ ................. ...........4.00. .... New Residential Occupancies__ --I-. IS Plumbing - V\ without fixtures .................1.......1.....4.00........4..00 1 D-500 sq. ft. $22.00 1501-1750 $34.50.............................. Misc. Ord. Current) ...............................I ..................... 501-750 24.50 1751-.20000 37.60.............................. Trut F 26.00 2001-22511 39.50.............................. 11 ...................................................................$B.00 751-1000 _%a TOTAL PLUMBING PERMIT FEE (plus penalty U�Ojg. 1_1) if 5.0 1001-1250 28.50 2261-2500 42.00.............................. 4 1251-1600 32.00 2501-2750 49.50..........a12.3............. APPLICATION FOR HEATING/COOLING PERMII` Permit Fee...............................................$6.00 T TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.C]) $55.00 PERMIT INSTALLATION l EACH FEE ). .12-10 Forced AirUnit..................to 100M ..................... 2.... .$ 8.00. .1.2._110 a 1,4 INSPECTION RECORD over 100M ........................ . 10.00.. ........... Comfort F I Cooling Unit......to 3 ton/HP ................. e.00... ........... Forms / Foundation .... Date:.. to 15 torl................ ...... . 9.50).............. -- Plumbing GGlifewd-Werk ........... . ... ..... 60 to 30 ton/HP............_.. ..........12.00. ...... A Electrical ....... .......... ir to 50 ton/HP......._........ -........17.00.. ...... urn Ing and Healing .... ... 'elf..... 'I Space Heater........ wall Heater ........................... 6.00 .......... tion & Energy_.................. ... ....Of. 'I ......1.. 3.00.. ........... Flues - other than above ..................................... ... 40Paume If Vent Fan: Kitchen...1... Bath 2.../Dryar...1_ 4 12-00 ift Test .................. financial Range Hood .......... 63:0000- cirary Power Gas / Elect. ....... 3 1 Com .... ..... ai - Electrical ....-.............................. Mill. (See Ord. Current..._........._.................................. ............... ........... V Final - Building/ Mechanical .............. ..........j..- Permit Fee ......._____.......................-.... ......_ i 6.00 Final - Design Review / Landscaping ...................... TOTAL HtgL/ Coolg. Permit Fee (plus penalty if app. 0) $ 30.00 Final- Public Wor ........... ........... I Ps. aj ;!Oba 1t1;/_L fix-iii-i, Let-, ilburnu Heal Lar.ARCO Ljbl� 9 %_Lill 0A. 1.1 1 73 rile No . Date 3J I,oca.ticn C ✓�h a —= e c •1 -ove:a S'f _ u Date i- o 0 CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO 7 > f.1 DATE I 19 g ( BLDG. PERMIT NO. > h aft THE BLDG. LOCATED AT 0�' t�. OWNED BY /J � /N-,^y�' �,,- � HAS BEEN ` OMPLETED) FOR USE AS � "' — f'ACf EDI k-: � A OM 1 Il BUILDING INSPECTOR BUILDING INSPECTOR'S OFFICE Bldg.Dept. CITY OF CUPERTINO Office Copy ❑ Backflow Device Sanitary Permit No. Sewer Connection - Plumbing Permit No. Plumbing Final j Lot No. Owner or Tenant At It,-) Tract Date Connected 19RiDate Final 190 p �—` PLUMBING INSPECTOR CITY OF CUPERTINO jF1 GAS SERVICE NOTICE V f � fvt l To ' Y06 are hereby authorized to connect the GAS service for t Owner or Tenant & /-)-5 /`1 L)V L At New Service j No. of Meters Reconnect No. of Add. Meters Move Service MoveMeter PLUMBING INSPECTOR- �i vut ELECTRIC SERVICE NOTICE OFFICE COPY BUILDING INSPECTOR'S NOTICE CITY OF CUPERTINO To You ore hereby authorized to Connect electrim4 service for Owner or Tenons /J`z � At / aL6 f�rtJ 1 (3k/ v No.of Wires Size of Wires Size of Switch Motor Load Voltage Phase I Heating Load K.W. Voltage {II ' ( Light s 110 No.of Meters New Service r Reconnect I I(/1 j Heal 120Three Wire More Service No.of Add.Meters PowerThree Phase Move Meter ©� ELECTRICAL INSPECTOR / 11