Loading...
1155 CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER �S S ` AND • . CERTIFICATE OF OCCUPANCY APPLICANT TO FILL IN BUILDING INSPECTION DIVISION STREET ADDRESS OF PROJECT: ................................................ s • . • Legal Description: Tract ...._.... ..._._ Block........... Lot...................... 7 criptien of Work: .... C.7!°:IL"01^o w'1'f..lr............ Plans Received B JZ Data .... ....... .. Q g �u...;t .SfJru.„!... ...................._...... ......_.....__........................._.. y............... .... `9......................... fJ REO.: Plans.... Survey.... CC,,�li Strut..... Energy.... Elec.... Mg,Ch.... 1st Struct. improvement on Parcel: Yes.... No.... Area of Bldg............... Plans Checked By............f3.t.!Jr............................Date /f ..... Separate Structure............ or Addition/Alteration to Exist. Bldg........... Application Approved By.........�4.4,.................:Date .. / .. fly..... No. of Stories................ Us of Bu�l ng ........... Validated B .Date ..7.. ............. Valuation of Project: $.... ........................:...................... ........... _ By................................................... ....... Compensation Certificate Verified By ... zr-� Date ....f!L/�t..... Owner: .Q1 .:. LN.PSQ.Sv.............. .....Y.. Phone: ...e._.2.(� Contractor: .. Rab LPNLt2-e.'{'C........Cit Bus. Lic. M .............. • • ' " • $ Contractor's Address:`7.�.`fq..at_ foe AK 6Aof.?.Ab Phone:l-5_'$ Permit Fee (plus penalty if applicable) ...... $..v.�-,T Contractor - Electrical: ....._....._.................__................................__.... ...... ........... .'.�....... j'b City Business License #.................... Phone:.................... ........)$ Plan Check Fee (less deposit of$......: Rct. #.. ...o�......�.. fPlumbing: .......... .......... ........................ Energy Plan Check Fee (Dep. of $........ Rct. #.........$....................... Cit ' Business License �".................... Phone:.................... Strong Motion Fee ........................ .��.........._�::;:;.....$.......i. ...... y / � � Heating and Cooling .................................................................. Plumbing Permit Fee ......_...____:../.......-..........[r•.$.................... 1 J "" City Business License x.................... Phone:.................... Electrical Permit Fee ...._..._.........A__........1.,yD^ $...................... Architect/Designer: Mach. Htg./Coolg. Permit $.....:...............`....... $....................... .................................................. Phone:.................... Eng-y Lender: .................................................................... Phone:................. own Residential Construction Tax ....._._..d._.....................$----------------------- fLender: .. ......................_..... ............................ ....... . ... ❑ Unknown Misc. Fee ..........................................._......�... $_... �.o...... .1- ... "I certif that in me pedormance of the work for which this permit is .......... Misc. Fee ...................................._._......._........: ...........$.... ....,..a...... y of employ any person in any manner so as to become subject / issued shall n • $ to the workman's compensation laws of California," SIGNATURE OF • - • 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. 1........................... Use Zone P.D. Conditions in Classification ...__........._........._........... is in lull force and effect: or ......rmi .......................arks..... aces............ Cond. Use Permit M............ Variance �'.....::..... Parking Spaces............ - � � � - I certify mat I am exempt from the "Licensed Required" provisions of the Approved B Date Contractor License Law. (State basis of exemption.) PP Y...... .����-�._-�_._��.--��- - - - - ----- -- I hereby acknowledge that I have read this application and state that the above is WORKS— •, REQUIREMENTS correct and agree to comply with all City ordinances and State Laws regulating bulhhng. t I (We) agree to save, indemnify keep harmless the City of Cupertino CfOBCtlment Permit......... Grant Of Easement........................ against liabilities, judgments, os and expenses which may in any way Irb, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... acture against said City in c s uence the granting of this pgmiy." ( war............ Cann. Fee $................ Water................ Meter $................ SIGNATURE. OF Agreement for Completion of Public Works ImprOVemeOiS ....._...._._.. APPLICANT/CONTRACTOR .. ....._...... _......... .. DATE / !< Plans Checked By........ Date...._... Approved By:....... Date............._:...- NOTE: when properly validated this form constitutes a Building Permit. This permit expires and becomes null and void should work not be commenced within APPLICATION • . ELECTRICAL PERMIT 120 days from validation date, or should authorized construction be suspended or abandoned for a period of 120 days after work is commenced. PERMIT INSTALLATION NO, EACH FEE APPLICATION • , PLUMBING PERMIT Light Outlets............ Switches:._........ Fixtures............ Receptacles............ PERMIT INSTALLATION NO. EACH FEE 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 Service — 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. $2.00..................... ............. Misc (see Ord. current).... . ................... Vacuum Breakers ........:................................... ..............3.50.. New Residential Occupancies Flat Rate Interceptor........ Water Softener........ .............................4.00. ............ Plumbing Piping without fixtures ...................................4.00,......... ..... 0-500 sq. ft..$22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) .................................................... 501-750 24.60 " 1751-20000 37.50.............................. Permit Fee '....$6.00 ...................................................................... 751-1000 26.00 2001-2256 39.50.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. ]) $ 1001-1250 28.50 2251-2500 42.00.............................. 1251-1500 32.00 2501-2750 49.50.............................. APPLICATION FOR HEATING/COOLING PermitFee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.0) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit.,....._.........to IOOM ..............................$ 6.00... ............ INSPECTION RECORD over 100M ........................ . 10.00.. ........... Comfort Cooling Unit.....Ao 3 ton/HP ........................... 6.00........:...... D Forms / Foundation ._..._._....._._.........I By:. . _... . ate:.........__.. to 15 ton/HP................ _ ........... 9.50........ .... Plumbing Ground Work ......_........_..-.1..... ......:......... .........._.......-__ to3Oton/HP..........................�..12.00. ............ ITh Electrical ............_...__............... .__.................... ......._................- to 50 ton/HP............_...........h..17.00.. ........... '1 - Plumbing and Heating ......._.........._.....:..:.... ..._._...... ...... Space Heater........ Wall Heater ................................... 6.00 .............. //11"t tion & Ener ....................... .................. a4r 9Y..... ... .... ... ... Flues - other than above .............................................I.. 3.00.............. t, /rest .......................................... . . ........................'.._................._._. Vent Fan: Kitchen........ Bath ........................................ .. 3.00............... porary Power Gas / Elect. ........ ..__................ .. .................__-: _ Commercial Ran a Hood 6.00... ._......... 4 g .......................................... .Final - Electrical ........................._.._.......................:....... ...................__.... Misc. (See Ord. Current.................._._..___............. Final - Building / Mechanical ..__.................................L........................- Permit Fee .........................._........ ._.. ..................$ 6.00... I Final - Design Review / Landscaping . .. :......................................... i ������������f 9 9 � �� TOTAL Hig./ Coolg. Permit Fee (plus penalty i app. ❑) $ Final-Public Works ........... ...... ....