1793 • CITY Or. CUPS@TINO •
SUPP EMEgTMJ
CITY OF CUPERTINO JA� 1
APPLICATION FOR RESIDENTIAL BUILDING PERMIT P PERMIT NUMBER
• AND
CERTIFICATE OF OCCUPANCY FOR APP7ANT TO FILL IN
BUILDING INSPECTION DIVISION STREET ADDRESS OF PROJECT:
wee ..._....;.-. ....._... ..10.179...Byer ly...G.k.. ._............_._......................
DEPARTMENT USE ONLY Legal Description: Tract.......655.1...... Block...... Lot..2.3...............
Plans Received8 Description of Work: _.._....s p
y......_........... Date ......................... solar......ei'init............._...... .............
REQa... . . ............__ _ __".___.._.._..at:... _ ....I . ....._ .r.a .._.__................_..
.: Pana.... Survey.... Coles: Struc..... 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.........................................Date No. of Stories............._ Use of Building
ValidatedB ...................._..._Date ....__............... ..............._ _............._......_._...
By -Ce Valuation of Project $..... __ __
Compensation Certificate Verified By ...... ......... Date .... .. Owner: ...... ... Phone: ..-
• • • Contractor: .... BAS HOMES_,...INC_.�ity Bus LIc. # .-..........
$
.. Contractor's Address: _......._...._._.._....._......__..._.. Phone:.................:..
Permit Fee (plus penalty if applicable) ........................$...24,®0.-..... Contractor - Electrical: ..._.___..._.._._.......__..................._.........-............
Plan Check Fee (less deposit of$--..... Rot. #.......... $......_.............. City Business License #.._-...-........... Phone:....................
Energy Plan Check Fee (Dep. of $........ Rct. #....--..) $...-....... ........ Plumbing: ..... .................._....._..._..._....................
Strong Motion Fee ....................................................... ..$...........!.�.r..TJ.-... City Business License #........... Phone:.............
Plumbing Permit Fee .......---....... .........__............. ..... Heating and Cooling .................... .___.._.
Electrical Permit Fee ........... ...................................$........_............. City Business License #.......___....... Phone:....................
Mach. Htg./Coolg. Permit $............................. $................_.-... Architect/Designer: ....._............ _ -........-..._....._. Phone:....................
Residential Construction Tax ........................__............$....................... Engineer: ._ ....._..._...__._..................._........_......... Phone: .
Misc. Fee Lender: . _ ..__. ........._.........._.__...___......_._..._....._...... Unknown
........................................................................$........--.............
Misc. Fee ............ ..............._..................__._....._......._.$. - "I certify that in the performance of the work for which this permit is
Issued I shall not employ an
........�"""' � y y person f any manner so as to become subject
• $ 24.50 to the workman's compensation laws of California."
SIGNATURE OF
•NING •UIREMENTS . 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 Users, No.
Use Zone P.D. Conditions in Classification .......- _..........._....... is in lull farce and effect: or
Cond. Use Permit #............ Variance #......... Parking Spaces....._..... . . I certify that I am exempt from the "Licensed Required" provisions of the
Approved By.............. ................ ....... Date """""""""' Contractors License Law. (Stale basis of exemption.)
I hereby mrm..ledge that I have read this application and state that the above is
_ res"Ifel NX.111111:I • correct and agree to comply with all City Ordinances and State Laws regulating
building.
nCfOBChment Permit........ (We) agree to save, indemnify and keep harmless the City of Cupertino................ Grant of Easement...-.................., against liabilities, judgments, costs and expenses which may in any way
Urb, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... - secure against said City in consequence of the granting of this permit."
Sewer............ 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
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
Light Outlets............ Switches_........-. APPLICATION ••
PLUMBING PERMIT
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.Oo...............
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. as Ord. current l.................. ..... Vacuum Breakers ... ..............3.50..............
New Residential Occupancies Flat Rate Interceptor........ Water Softener........ ............
..... 4.00
0-500 aq. ft. $22.00 1501-1750 $34.50........................... Plumbing Piping without fixtures... 50:1:8P::..E .;t
Misc. (Sae Ord. Current) .......... . .... .................
501-750 24.60 1751-20000 37.60.............................. Permit Fee .. ..........$6.00
TOTAL PLUMBING PERMIT FEE (plus penalty if app:
761-1000 26.00 2001-225C 39.50.............................. .. ...........................a ......pp.'
1001-1250 28.60 2261-2500 42.00.............................. p) $ 10.00
1251-1500 32.00 2501-2760 49.50..............................
APPLICATION FOR
PermitFee...............................................$6.0o
TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.0) $ 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 ton/HP......................... 9.50..............
Plumbing Ground Work . _._............_. .... -_............. . ......._._........... to 30 ton/HP...........................12.00. .
Rough Electrical ..........-
....._...._._... _.._..._...._. ......_..._._.._._.... to 50 ton/HP...........................17.00.. ...........
Tame - Plumbing and Heating ..._ .I . ..__......... ........_...._-......_.. Space Heater........ Wall Heater ................................... 6.00..
sulation & Energy................_........... ......
......... __...................... Flues - other than above ..........................................-.. 3.00..............
as Test .
- - --- -- Vent Fan: Kitchen .. Bath 3.00.
Temporary Power Gas / Elect -
- "".. - Commercial Range Hood ... .. 6.00, .
Final - Electrical .- ...... ._. .... .... Misc. (See Ord. Current.....
Final - Building/ Mechanical .. _L.. _. -
Permit Fee - ...................... $ 6.00
Final - Design Review / Landscaping .. -�
TOTAL Hi Coolg. Permit Fee (plus penalty if app. [1) $
Final-Public Warks ....:......................................................