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1707 >' CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER 112o7 • AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION ST �FFrT RESS F RO,}E61T• ..eG<.��tion: 'rat(p .... Bl............_.... -.......�_ ...--- DEPARTMENT • Legal Description: Tract.. YJ...../Block �t.... .. Descriptigpyf Wor kL ......... % A�_. iLv�....._................... Plans Received By................ 1._7......................Date�/,)L .�...... ....._......._/c.L4/ll.:ar¢LCS,M__.................................................................. REO.: Plans.... Survey.... Celcs: Struc..... Energy.... Elect..... Moon.... 1st Struct. Improvement on Parcel: Yes.... No... Area of Bldg............... Plans Checked By.............:................. .........Date j.� Separate Structure............ or Addition/Alter 'on i Exis Idgr�...... Application Approved By.................l...L...........Date ...... .?f .. No. of Stories.....2.... Use ulldin yy . Validated BY.............................................__.`.....Date .............. Valuation f Proje t $ .. . C-.. ............_...L...... 9 Compensation Certificate Verified B ...... Date ../:?� i/. qq _._................... P Y - - Oa Owner: ' • • $ 79. (3Y1T) Contractor Gy. do ....G,v...... City Bus. Lia # .............. Contractor'sAdcres�.e.�_15 !.vi.ay..00.// dwPhone:..............._... Permit Fee (plus penalty I applicable) — Contractor - Electrical: _._......_........_.._.........._......_............................. P Y PP ) ........................$..>a�.. ............. City Business License •.............—.... Phone:.................... Plan Check Fee (less deposit of$.......... Rct. #..........)$...... .... Energy Plan Check Fee (Dep. of $........ Rot. #........) $-..... r.v?.. Plumbing: ...................................................................................... Strong Motion Fee ..........................................................$.........:5->1-.� City Business License •...—.............. Phone:.................... Fi Heating and Cooling _....._.... ................................................... Electrical Permit Fee .........................._....._.............$.... ....!!.<......... City Bust ss licenser . ._...__. .... Phone:...... ...... ElecVical Permit Fee ..................................................._.$$ ....ta.h.r. s�... Architect/Des' ne -f..¢. N . Mach. Htg./Caalg. Permit $............................. $...,3:•3..r..�Y... ......... Engineer: - - -- - Phone2�1Residential Construction Tax .......-.............................$............. .. .... ... _.............. ❑ Unknown Misc. Fee $....................... nce ...................�...............r................. - AP _ql certify that in the performance of the work for which this permit is Misc. Fee ........................................................................$....................... slued I shall not employ any PersonWmannostoma aublecl $ io the workman's comer/r�Ion/I yv�• SIGNATURE OFi�39��NT a workm s�Jc•Q�Environmental Status: Exempt ....-..... Other............... ................ "I certify that os rile applicant ais a e Design Review Approval: Bldg. .........:.. Site ............ Sign ............ Contractors License Law one further that my Licens. No, l�S. x Use Zone ......—... P.D. Conditions _........................................................ ..in 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 Contractors License Law. (State basis of exemption.) Approved By............ ............. ........... Date ..........._.............. 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. 1 (We) agree to save. Indemnify and keep harmLsiss the City pt Cupertino ncroaohment Permit........................ Grant of Easement........................ against liabilities, judgments, co is and ex e h ay in any way Ourb, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... acture against said City In equ a of this permit." Sewer............ Conn. Fee $............... Water......._......- Meter $................ SIGNATURE OF •� �rr'' Agreement for Completion of Public Works Improvements .................. APPLICANT/CONTRACTOR ....._.. _. DATE Plans Checked By........ Date........ Approved By.__._ Date.................... NOTE: When properly led this m netitutes Building Permit. This permit expires and becomes null and void should we not,be commenced within • • 120 days from validation date, or should al flited construction be suspended or abandoned for a period of 120 days after work is commenced. PERMIT STALLATION NO. EACH FEE APPLICATION„ FOR PLUMBING PERMIT t Lighi Ou a s..!0... Switches.1.7... Fixture .... Receptacles.3:f.... �a PERMIT INSTALLATION NO. EACH FEE TO AL•NUMBER (less than 1000 watts) ... -... $ .50 J Gas System with up to 5 outlets ......................... .......$4.00........,,._.. sill. c� Range... . . Cooking Unit........ Oven...�...... ......... ... 2.00 .. .....J:...� Each additional outlet ...................................... ..... 1.00..........�.h..'. I Dryer_ . Garb. Disp...../. Dishwasher ./.._..... _. 2.00 ......�_c� Water System (Installation, Alt. or Repair) ......... ...... 4.00.......v..� Q MOTORS: 1 HP or less _.............. .... ......._...... ._ . 2.00 - �rN Water CISped. Water Heatercl. Ld. Tray........... . 4,00. 1 Greater than 1 HP not more than 5 HP .........._.. . 3.50 .........._.. Lavatory. . Shower Pan.(. Bathtub).. Sin'it'....��h1 3.00 rO..D V .l. Temporary Power Pole or Service — 100 amp . ....... ..5.00 .. ............ Wash. Mach./.. Dishwashe'r.//. Garb. Disp..../.....,7...... 3.00..... . (1y tV —200 amp......... 7.00 .............. Sewer ...._......./.0,�/.r..T....t$f�.....................1....... 8.00.. -'1 Time Clock .........._ ...... ... ............. ......... 1.50............... Lawn Sprinkler Ys. 5.0 Ea. add Sys. $2.00........ ............. ... �fl Misc. (see Ord. current 1.......... .. ........................................ Vacuum Breakers ............................................ ..............3.50.............. Y New Residential Occupancies Flat Rate Interceptor........ Water Softener........ .............................4.00. ............ Plumbing Piping without fixtures ...................................4.00............... 0-600 Sq. ft. $22.00 1501-1750 $34.50........................... .. Misc. (See Ord. Current) .................................................,•, 501-750 24.60 1751-•20000 37.60.............................. Permit Fee .............. .. 751-1000 26.00 2001-2256 39.50.............................. MI ............................lty i....................$8.00 1001-1250 28.50 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. [�) E P!D 1261-1500 32.00 2501-2750 49.50.....:........................ • s • HEATING/COOLING Permit Fee...............................................$c�6.00 , TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.0) w0� 071 . PERMIT INSTALLATION N0. EACH FEE Forced Air Unit..................to IO ................... .. . .. .....E 8.00.... ........ f INSPECTION RECORD overer 100M ........................ . 10.00.. ........... C 1981 Comfort Cooling Unit......to 3 ton/HP ......._............... .. 8.00............... r� Forms / Foundation .......... By:_ . ..... . Da to 15 ton/HP......................... 9.50............... +� Plumbing 6wuar-MJerk . I .s^'�.. . P XV ... .. 1 to 30 ton/HP............................12.00. ............ 'v`'� ''/'` Ir Rough Electrical ..............U.......�...........�... .. ... .21-p'.z.. \ to 50 ton/HP............................17.00............... Space Heater........ Wall Heater .. . - - - . Commercial R 8.00,,,„ �z rame - Plumbingand Hearin ....... .... ...........-.......... er than 9 ... - ............._ Vents Fan: Kitchen....above H Bath .. ........._....._...... I .. .. 3.00......�<..... T.Qw,; ion 8 Energy._.._..........._........ ...... ..... ._..... .... .. Miscm ee r angary oo _.............................. es Test ........................_......_ ...... C'^LLXIi:..... .. .... S O tl. Cu ant..._............ ... .. ._.. .. ....�........................... MD G..... Final - Electrical .....P / L............. ( CL Final - Building/ Mechanic .........-........... .......! ....G.. .(............. Permit Fee ........_......................................:........................ $-6.00 Final - Design Review r Landscaping . ..... ..._....... ........ ................. TOTAL Htg./ Coolg. Permit Fee (plus penalty it app. p) $33 UD Final-Public Works ...................................... ...........%./ v,F�. 3-�z -�� a �' �/S•sR �/9/9i �• f-�.��f y�yr.�,ro,/s-��at Pr,�