Loading...
1378( CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY 40 BUILDING INSPECTION DIVISION Plana Received By .................................................... Date ......................... REO.: Plans.... Survey.... Calcs: Struc.... . Energy.... Elect..... Mach.... Plans Checked By .................................................... Date .... / Application Approved By ........... .....4 ................ Date ...1gl1vao ValidatedBY.............................................................. Date ........................ Compensation Certificate Verified By ...... _......... . Date _.......... ............. •' • $�d� d'•D"d y1 d� Permit Fee (plus penalty if applicable) ........................ $..vro�............ Plan Check Fee (lessldepo0Gf $.......... Rct. #..........) $....................... Energy Plan Check�Fee (Dep. of $.: ;..... Rct. #........) $............... .. Strong Motion Fee ......... �l $..........,5� .......................... Plumbing Permit FedG`...��........................................... $--.f..Ll..("'�. Electrical Permit Fee'..` ............... . ...................... $........ ....... . Mach. Htg./Coolg. Pegnit g.............. ....... Mach. Residential Conslructioh'Taz........................................ $ ....................... Misc. Fee ............................................ _.......................... $ ....................... Misc. Fee....................................................................... $$.-.... z... ....-- Design Review Approval: Bldg ............. Site ............ Sign ............ Use Zone ............ P.D. Conditions............................................................ Cond. Use Permit a............ Variance ♦.... .--- --- Parking Spaces............ ApprovedBy ........................................................... Date ........................... :roachment Permit ........................ Grant of Easement........................ .rb, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... ewer............ Conn. Fee $................ Water................ Meter $ ................ Agreement for Completion of Public Works Improvements .................. Plans Checked By........ Date........ Approved By........ Data .................... ( Q PERMIT NUMBER I /3 7J STREET ADDRESS nF "Rn.IFCT: ~•i .................. Legal Description: Tract ............... Block........ Lot...................... DesciPti n of Work: ... .................................................................. .S;a.9 R.....iahAq..................................................... 1st Struct. Improvement on Parcel: Yes.... No... Area of BldgAZW... Separate Structure........... or Addition/Alteration to ExA�tt. Bldg........... No. of Stories ....... Use of Building .Sl1N6j:..4,..da.tnf$ ......... Valuation.2I Project: $.../.Q/. .. ..............a.� Owner:..IJ ole... OL.Rv 4►�..................... Phone:.Iw....rfic .... Contractor: .............. 4/._ .. ........ City Bus. Lic. N' .............. Contractor's Address: ._Q r.�. �...�i�9.4tiela✓ Phone: .................... Contceets al: .COs .............. .................................... City Business License #... ....... ......... Phone:.................... Plumbing: ............ ............. ........................................................... City Business License A...................Phone:........... ....... Heating and Cooling ...... Q{V11.�Y.._..y w.� ftft City Business License 0... ...... .......... Phone:N Architect/Designer:................................................. Phone:.................... Engineer: .........................................._........................ Phone:.................... Lender: ...................................'".................................... 0 Unknown _.. ._ "I cerlify 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 the workman's compensation laws of California." SIGNATURE OF APPLICANT/OWNER 'rl410 ... GATE ... 9 . .... A certify that as the applicant I am licensed uncle' the provisions of the Contractors License Law and further that my Llcena. 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 building. I (We).agree to save, indemnity and keep harmless the City of Cupertino against liabilities, judgments, costa and expenses which may In any way secure against said City In consequence of the granting of this permit." SIGNATURE SIGNATURE T/OF� /9� DATE �..�.r APPLICANCONTRACTOR NOTE- When properly validated this form constitutes a Building Permit. This permit expires and becomes null and void should work ful wmmenced withbt 120 days from validation date, or should authorized constriction be suapeMed •f abandoned for a period of 120 days after work Is commenced.' i'._, PERMIT INSTALLATION NO. EACH FEE I,° 1 \ ••. PLUMBING Light Outlets.......Switches............ PERMIT INSTALLATION � NO. EACH - FEE Fixtures............ Receptacles TOTAL NUMBER (less than 1000 watts) ............ $ ,50 .. ............ Gas System with up to 5 outlets .................................$4,00. --:.......... 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, .............. MOTORS: 1 HP or less ................................................. 2.00 .. Water Closet.... Water Heater.... Ld. Tray..................... 4.00.............. Greater than 1 HP not more than 5 HP ............... 3.50 .. ............ Lavatory.... Shower Pan.... Bathtub.... Sink................... 3.00.............. Temporary Power Pole or SdMce — 100 amp ..........5.00 .. ........... Wash. Mach..... Dishwasher.... Garb. Disp ..... ..... ........ .. 3.00.............. — 200 amp. . 7.00,.. __ .... Sewer............................................................................... 8.00............... Time Clock .............................. _.... .... ............. .... __.�...... .. 1.50 ... ............ ``�� Lawn Sprinkler Sys. $5.00 Ea. add Sys. 82.00.................................. Misc. f see Ord. current 1 ...................................................... V Vacuum Breakers ............................................ ..............3.50....:..._._ New Residential Occupancies Flat Rate Interceptor........ Water Softener ......................... ........»..4,00.....: 0-500 aq. ft. 822.00 1501-1750 834.50 .............................. ...... 3o Plumbing Piping without fixtures ...................................4.00.. IMisc. (See Ord. Current) ................................................. 501-750 24.50 1751-•20000 37.50 .........................« 761-1000 26.00 2001-225C 39.50 .............................. Permit Fee ..............................................ally. If app. ........... $ 8.00 TOTAL PLUMBING PERMIT FEE (plus anal it a toot—tzso 28.60 2251-2500 42.90 .............................. � penalty DP• O) $/o /'a 1251-1500 32.00 2501-2750 49.50 .............................. tvAPPLICATION FOR HEATING/COOLING PERMIT PermitFee...............................................$6.00h TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.0) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M .............................$ 6.00.............. • • ' r over 10OM ....................... . 10.00 ............. �3i Comfort Cooling Unit...... to 3 ton/HP ................. ........ I.. 6.00 ... ........ _. _ Forma / Foundation ............................ B ...... Date....y......... to 15Ion/HP ................. .......1} 9.50.. .......... _ e-Plumbin .... ..................... I..... to 30 ton/HP................. .......T. 12.00. 3 1 s TTTT .........._ ough Electrical ................. _.................;... to 50 ton/HP ................. ....... 17.00............. PlumbingGround Wod Heating I... ........... ............'.........•..... g .......... Space Heater........ Wall Heater ................................... 6.00............. .lotion & Energy . ........... _...............1.................................................... Flues - other than above ..................................... .......�.. 3.00............. .d9^Test............. ..... ... ..........................._..................'.......................... Vent Fan: Kitchen........ Bath ............................... ........ .. 3.00... em orar Power as G /Elect . ..... .... ............ .. ................... p y - �- � � -- �- � • Commercial Ran a Hood 8.00-, Final - Electrical........................................................................................ Misc. (See Ord. Current....J�!IY.Q/.AeJ..T..T ................. .. .. .. Final - Building /Mechanical ....................... ................I.......................... Permit Fee........................................................................ $ 6.00 Final -Design Review /Landscaping ....... ..................... ..................... ` TOTAL Htg./ oolg. Permit Fee (plus penalty if app. p) 16 $/0,� orb Final — Public Works ......................................................