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1025CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION 4f•sampi-EMEMPM Gr Plans Received By ....... ;Adl- ) ............................... REQ.: Plans.... Survey.... Calcs: Struc ..... Energy.... Elect ..... Mach .... Plans Chocked By .................. I Date ...... .. ........ ............ �� Date Application Approved By .......4...L. VA0 ..... ValidatedBy .............................................................. Date ........................ Compensation Certificate Verified By ................. Date ......................... • 072IMM-117MIIIIII $ - 0 -CJ Permit Fee (plus penalty if applicable) ........................ Plan Check Fee (less deposit of $.......... plot. #..........) $.... a .............. Energy Plan Check Fee (Depil Rot. #........) $ ....................... . - 7 _ Strong Motion Fee ..................................._.... :� ........... $....................... Plumbing Permit Fee .......I......;- ...................... ....... $ .................. Electrical Permit Fee ......... $ Mach. Htg./Coolg. Permit $ ............................. J $....................... Residential Construction Tax -.. ........... . ........................ $ ....................... Misc. Fee ........................ ............... .... ........$......... Misc. Fee ..................................................... ................ ... $..................... ................ Environmental Status: Exempt ............ O'her ........................................ Design Review Approval: Bldg ............. Site .... __ .... Sign ............ UseZone ............ P.D. Conditions ............................................................ Cond. Use Permit #............ Variance #............ Parking Spaces............ ApprovedBy ........................................................... Date ........................... 0 -yoachment Permit ........................ Grant of Easement........................ I .6, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... war............ Conn. Fee $ ................ Water................ Meter $................ g o reement 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) .... $ .5o . .... .. .. Range........ Cooking Unit........ Oven ....................I....... 2.00 .. .. . .. ... Dryer........ Garb. Disp ... _ .... Dishwasher ............ 2.00 .. ............ MOTORS: I HP or less ......................................... I - 2 00 .. ............ Greater than 1 HIP not more than 5, 1 3:50 ......... Temporary Power Pole or Service - 100 amp . . .... .. 5.00 .. ........... - 200 amp. 7.00 ... .......... Time Clock ................. 7 .................. ............. I ....... . 1.50 ... ........... Misc, (see Ord. current ,...................................................... Now Residential Occupancies Flet Rate 0-600 sq. ft. $22.00 1501-1750 $34.50 .............................. 501-750 24.60 1751-20000 37.50 .............................. 751-1000 26.00 2001-225C 39.50 .............................. 1001-1250 28.50 2251-2600 42.00 .............................. 1251-1500 32.00 2501-2750 49.50 .............................. Permit Fee ...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (plus penalty If app. $ Forms / Foundation ............................_I By:......._ . Date:................ Plumbing Ground Work . .__ ........... j__ - .... ....... .... - ............. : ...... RoughElectrical ... ............................ ...... . .. ... .... ..................... Mnelumbing and Heating ..... ............. ,.tlmdP n9 Energyirgy ............. _ ........... ................. ................... migorary Power ..................... ........... ............... Final - Electrical .................. .. ..... ..................... Final - Building / I ........ .. I ............. I .......................... Final - Design Re.......................................... Final -Public Works ........................................................... PERMIT NUMBER [ 10AS FOR APPLICANT TO FILL IN ­� STREET A--CIESS OF PROJECTS 7,36'-L»/S--S`. .......__/ 0 . 7 7. ..w..7.... ................................... I .( .. Legal Description: Tract ­­ rl�jock ............ Lot...................... Description of Work: ....... 7. . . .......................... ............................. ........................................... .................... tat Struct. Improvement on Parcel: Yes.... No ... Area of Bldg ............... Separate Structure............ or Addition/ Alteration to Exist. Bldg........... No. of Stories ................ Us of Building .... ............ ............................... Valuation I Project; $......... .................... Owner: i50­e.1_T140L'A ...... . .......................... Phone Contractor: .. ... ...... - .... w . . .... ......................... City Bus. Lic. # .... Contractor's Address:..........- ................................... Phone:.................... Contractor - Electrical: ............ ................... ............................................. . City Business License #.................... Phone:.................... Plumbing: . ......................................... ... I ... I .................................... City Business License # .................... Phone:.................... Heating and Cooling .. ...... ........ ................... ... ... .......... City Business License # .................... Phone:.................... Architect/Designer:.............................. _ .................. Phone:.................... Engineer: ... ... ..... ...................................................... Phone:.................... Lender: . .. ..... - ................ .... ........................................... .. 0 Unknown "I certify that In the performance of the work for which this permit 18, issued I shall not employ any person in any manner so as to become subject he w, omla." '0 1 )F %Is" a I Callr� DATE... SIGNATURE ( ny APPLICANT/O ......... - ................ I certify that as the applicant I am licensed undo- the provisions of the Contractors License Law and further that my Licens, No . ............... _.. ...... in Classification ........................................ Is in full force and affect: or Icedify that I am exempt from the "Licensed Required" provisions of the Contractors License Low. (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 b.;Id,nq_ 1 (Ws) agree to save, Indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may In any way secure against sail g of thisfrilt - SIGNATURE OF APPLICANT/CONTR,IL al the LJ 4CT=O .... I ........... 11 ................................. DATE NOTE- When property validated this farm constitutes a Building Pernift. This permit expires and becomes null and void should work not be commenced Within 120b,from a authorized construl be suspended or =dr al Ildation date, or should auth o Period of 120 days after work Is commenced. APPLICATION FOR 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 Floater.... Ld. Tray ........... ........ .. 4.00• .............. Lavatory.... Shower Pan.... Bathtub.... Sink......_........... 3.00 .............. Wash. fill Dishwasher.... Garb. Disp ..... ..... ........ .. 3.00 . .............. Sewer..................................................................... ........ .. 8.00 . .............. Lawn Sprinkler Sys. $6.00 Ea. add sys. $2.00 Vacuum Breakers ............................................ Interceptor........ Water Softener ......................... ............ Plumbing Piping without fixtures ...................................4.00.............. Misc. (See Ord. Current) ......................... I ........................... PermitFee ............ ................................................ . ........... $6.00 TOTAL PLUMBING PERMIT FEE (plus penalty If app. 71) $ APPLICATION FOR HEATING/COOLING I'll 0. PERMIT INSTALLATION 0. 1M EACH FEE Forced Air Unit ..................to 100M ..................... .........$ 6.00 ... ........... over100M ....................... . 10.00 ............. Comfort Cooling Unit...... to 3 ton/HP ................. .......... 6.00 ... ........... to 15 ton/HP................. ...... 9.50 ............. to 30 ton/HP .......................... 12.00 . ............ to 50 ton/HP ................. ...... . .. 17.00 ............. Space Heater........ Wall Heater ..... 6.00 .. ........... Flues - other than above ............ 3.00 ............. Vent Fan: Kitchen........ Bath ............................... ....... 3.00............... Commercial Range Hood ............... ................ ...... 8.00 Misc. (See Ord. Current .................................. _ . I ....... I .............. il PermitFee ............................................. ........................... 6.00 TOTAL Htg./ Coog. Permit Fee (plus penalty if app. [2) $