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1766 CITY OF CUPERTIP40 CITY OF CUPERTINO JAiq 1981 PERMIT NUMBER 1766 APPLICATION FOR RESIDENTIAL BUILDING PERMIT AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STR ES 3EADD PRO CT: ...................................... Legal Description. Tlac ... .. ............JBIOQK..........- LL........ .. Descriptio or Of Work: . .... PlansReceived By....................................................Date ......................... .................-.................................. . ..... REQ.: Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach.... 1st Struct. Improvement on Parcel:Yes.... No....Area of Bldg............... Plans Checked BY............................. Data Separate Structure............ or Addition/Alter tion to Exist. Bid c.,. ...... !"TT, No. of Stories......../...... Use oeufi5inc,��...... Application Approved By.....................f.. .....*��_*�'�O'.t: Validated By.......................................... .................... Date Valuation of Project: &. . .....&-.. .......... ....a............... te.c.t.: ...... Phone: ,a Compensation Certificate Verified By ............... Date Owner:c)y Contractor: .. r S -..CJty Bus. Lic. #06- it. • $ 3.0 o Contractor'Xddress.i ..�J.qo........s Phone:.2J1?(,...__.. Permit Fee (plus penalty if applicable)I........................$..V.ZlrtE..... Contractor - Electrical: .................................................... ...........*....... Plan Check Fee (less deposit of III.......... Rct. #..........)$....................... City Business License #.................... Phone:.................... Energy Plan Check Fee (Dep. of $........ Rct. #........)$.............- Plumbing: .........__......_....................................... **...... .......... I D. Phone:.................... Strong Motion Fee ..........................................................$........e... ........ Heating and Cooling ........... **... ...**City Business License #.................... ...*...........j...... Plumbing Permit Fee ................................................$....................... City Business License #.................... Phone:.................... Electrical Permit Fee ......................................................$....................... Architect/Designer: .............................. Phone:.................... Mach. Htg./CooIg. Permit $............................. $....................... .............Engineer: ........... ...................................................... Phone:.... __....... Residential Construction Tax ........................................$....................... Lender: . ......................._----..........................................._.. E] Unknown Misc. Fee ........................................................................$......(.,VL�.. "I certify that In the performance of the work for which this permit Is Misc. Fee ........................................................................$ issued I shall not employ any person in any manner so as to become subject (a the workman's$ man a compensation laws QtCallforri SIGNATURE OF A5P,L.1CANT/OWNE.R *,,,,,d.......d......in OATEJ�..ml�t4 V k r4 u I certify the applicant alcV.,ri u P to a the h, - fjel� ' 'a 'q Environmental Status: Exempt............ Other....................................... e..V1Jh. spot t - , un " Design Review Approval: Bldg. ............ Site ............ Sign ............ Contractors Lice Law and runner that my Lken., No. I. Cl... I ifical on Use Zone ............ P.D. Conditions ............................................................ ..... .............. Is in full force and a fact:or Conal. Use Permit #............ Variance #............ Parking Spaces............ Contractors that I am exempt from the "Licensed Required" provisions of the Approved By................................................._........ Date ........................... License Law. (State basis at exemption.) I hereby acknowledge that I have read this application and state that the above is A,rrect 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 iftroachment Permit........................ Grant of Easement........................ against liabilities, judgments, costs and expenses which may In any way Gutter, Sidewalk, Driveway; Replace.......... Repair.......... accure against to Cit In sequence a granting of thl It Conn. Fee $................ Water................ Meter $................ SIGNATURE OF I lq?9Wre1em111e11n*1t111for Completion of Public Works Improvements .................. APPLICANT/COO ......... ...... DATE 0 g qP )!.M# eti Be APPLICANT/CONTRACTOR Y. , A re Plans Checked By........ Date........ Approved By........ Date... .......... NOTE: When property v staff this i Iliturters, a building P It. This run -PERMIT permit expires and becomes null and void 'Jld work not be common"d within APPLICATION FOR ELECTRICAL l2: v days from validation date, or should authorized construction be suspended or b . rated for a period 120 days after work Is commenced. L11 if PERMIT INSTALLATION NO. EACH IFEE APPLICATION FOR PLUMBING PERMIT Light Outlets............ Switches............ 7-TUSr FEE Fixtures............ Receptacles............ PERMIT INSTALLATION N 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..................... 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.... Let.Tray..................... 4.00. ............. Greater than I 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 ......................... New Residential Occupancies let Rete Interceptor........ Water Softener... Plumbing Piping without fixtures ...................................4.00. ............. D-600 sq. ft. $22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) .................................................... 501-760 24.50 1751-20000 37.50.............................. Permit Fee .......................................................................... 751-1000 26.00 2001-2250 39.50.............................. I TOTAL PLUMBING PERMIT FEE (plus penalty if app. C]) III 1001-1250 28.50 2251-2500 42.00.............................. - 1251-1600 32.00 2501-2750 49.50.............................. APPLICATION FOR HEATING/COOLING PERMIT Permit Fee...............................................$6.00 ... - _ 0. TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.0) $ PERMIT INSTALLATION ITO.W US FEE Forced Air Unit..................to 100M ...............................If 6.00............... INSPECTION RECORD over 100M ....................... . 10.00........I..... I Comfort Cooling Unit......to 3 ton/HP .......................... . 6.00............... Forms / Foundation ............ .. .............. BY:........ ........ Date:................ to 15 ton/HP......................... 9.60.............. Plumbing Ground Work ...................... J_ . ................ ........................... to 30 ton/HP................. ..12.00. ......... Rough Electrical ................. .................J... ......................................:......... to 50 ton/HP.......................... ..17.00.. .:......... -`,nme - Plumbing and Heating ........... Space Heater........ Well Heater ....................:.. 6.00 lation & Energy................. ............ ............ ....... ........................... Flues - other than above ................................. 3.00:: Test __............................. .. . ... .. .11, . 'I - . ....... Vent Fan: Kitchen........ Bath ................... 3.00... Omporary Power Gas / Elect. ........ .. ................. ........................... Commercial Range Hood .............. 8.00... ........... ........... Final - Electrical ............. ...................... ................... ........................... Misc. (See Ord. Current............................................... ............... ........... Final - Building/ Mechanical ............. ...................... Permit Fee ................................ 6.00 Final - Design Review / Landscaping ...... .........I __..................... TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. 0) $ Final-Public Works ........................................................... I