Loading...
1478 0 CITY OF CUPERTINO PERMIT NUMBER,,-�APPLICATION FOR RESIDENTIAL BUILDING PERMIT AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STY(E )V4D1PJrRrDP1R�J J!CT'_Dflitil=�__................................ Legal Description: Tract..... Block............ Lot...................... Description of Work: I XW14725...................................................... PlansReceived By....... .....................Date .....................___.....­­­­......... .................................. REO.: Plans.... Survey.... Calcs: Strut..... Energy.... Elect....- Mach.... 1st Struct, Improvement on Parcel: Yes.... No... Area of Bldg............ Plans Checked By........................ .... Date Separate Structure............ or Addition/Alteration to Exist. Bldg........... Application Approved By...........4.,_4..................Date No. of Stories................ Use of Building ....._.......... .............................. Validated By.................................................. Date ........................ Valuatio of Project: $ ....................C_......liq....................... 10, • Compensation Certificate Verified By .............._ Date ......................... Owner 00... ........ Phone:` ._6 Contractor: . ............. .........._.................City Bus. Lia # .............. lcamn�� $ 4,0o Contractor's Address: ...................__........................ Phone:.................... Permit Fee (plus penalty if applicable) ......... .............. Contractor - Electrical: . ___.... ..... .......... ........ ......... ................... Plan Check Fee (less deposit of $..._.......... Rct. #.-_......) ...... City Business License #,,,._,,,,.__._._ Phol ................. Energy Plan Check Fee (Dep. of $........ Rct # $ Plumbing: ....... ........... ............................... TZ City Business License #.............__... Phone:................ Strong Motion Fee ............................................ .......... ........... ....._ Heating and Cooling ....... .__.......... ................_ _................ Plumbing Permit Fee ................................................ ................... City Business License #.................... Phone:.................... Electrical Permit Fee ...................................................... .................. Architect/Desi gner: .............. ......___............. .. Phone: ................_ Mel Htg./Coog. Permit $............................. ................ Residential Construction Tax ... Engineer: .... ..... ...... ..._........._..................... ... Phone:............... _ ............ ....... ............... Lender: . .. .............. ......_ _ ........... ........... ............ [] Unknown Misc. Fee ......__................................................. .........$...__//..VV Misc. Fee ..... ............................... I certify that in the performance of the work for which this permit Is d Ishan he t loy person in any manner so as to become subject • $/ :sl workman's c`2 ar=lawsY)"offal SIGNATURE OF APPLICANT1OWNERJ;d10�d.`t".....61AMJ. ..... DATE................ Environmental Status: Exempt Other .............................. I rierily that as the applicant I am licensed once the provisions of the Design Review Approval: Bldg. ............ Site ....... Sign ............ Contractors License Law and further that my Unions, No. ........................... Use Zone ............ P.D. Conditions ...._............. ............._............ ht Classification .......-...........-..........__ is in full force and effect: or Cond. Use Permit #............ Variance #............ Parking Spaces............ I certify that I am exempt from the "Licensed Required" provisions of the Approved By. Contractors License Law, (Slate basis of exemption.) ................. .................. ................. Date ...... ............... I hereby acknowledge that I have read this application and state that the above is correct rod 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 lip ,roachrnent Permit... .-.. Grant of Easement..._... ............... against liabilities, judgments, costs and expenses which may in any way ;b, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... occurs against said City in consequence of the granting of this permit." -,ewer............ Conn. Fee $................ Water................ Meter $......._.. ... SIGNATURE OF Agreement for Completion of Public Works Improvements ...........___ 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 12D days Iran validalion date, or should authorized construction be suspended or abandoned for a period of 120 days after work is commenced. PERMIT INSTALLATION NO, EACH I FEE APPLICATION FOR PLUMBING PERMIT Light Outlets....._..... Switches.........._ ._­0_ I 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 -- --- .1.._ Sewer .....___......................_...._.............................. .. 8.00............... Time Clock ......__........ ...... ................__..... ................ 1.50............... Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00..................... ............. Misc. (see Ord. current)..... ................................................ .................................. Vacuum Breakers .........................__.............. ..............3.60.............. New Residential Occupancies Flat Rate Interceptor........ Water Softener........ ............... - Plumbing Piping without fixtures ...................................4.00_ 0-500 sq. ft. $22.00 1501-1750 $34.50.............................. if app. 0) $ Misc. (See Ord. Current) ........................ .............. 7,51-1000 26,00 2001-225C 39.50..........................­* 501-750 24.60 1751-.20000 37.50.............................. Fee ............._.................._..........alty.......................... I Permit 1001-1250 28.50 2251-2500 42.00...........................­ TOTAL PLUMBING PERMIT FEE (plus pen 1251-1500 32.00 2501-2750 49.50.............................. APPLICATION FOR HEATING/COOLING PERMIT Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty it app.C) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..............._to 100M .......................$ 6.00... ............ INSPECTION RECORD over 100M ................ ......... 10.00.............. Comfort Cooling Unit......to 3 ton/HP ........................ .. 6.00.. ............ Forms / Foundation ..... . ...... ....... By:._.__. ....... . Date:................ to 15 tol................. ........f. 9.50.. ............ Plumbing Ground Work ....... .... .... .............. to 30 ton/HP........_...... ....... ..12.00. ............ Rough Electrical ........... ................. to 50 tot...........................17.00.. ............ a The - Plumbing and Heating ............. Space Heater........ Wall Heater ......................_.......... 6-GO IMFulation & Energy......._ . .... ..... . ....... _.......... Flues - other than above ............___.................. ........ 3.00.............. .Is Test ....... .................. Vent Fan: Kitchen........ Bath ....................................... 3.l Temporary Power Gas / Elect. .... .. ......... ....... ................ Commercial Range Hood ....... ....... .__ 6.00............... Final - Electrical ......... .... ........ _....._...__......._I ............ Misc. (See Ord. Current......._._.__....................... .......1..­...................... Final - Building/ Mechanical ..........._ .......................IPermit Fee .......__ : , .................................... $ 6.00 Final - Design Review / Landscaping . .... ... . ......................... TOTAL Htg./ Coo1g. Permit Fee (plus penalty if app. E]) $ Final-Public Works ...........................................................