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1786• RIn OF. CUO PPLEME'NTA]p,Qj CITY OF CUPERTINO ,IAN 1 APPLICATION FOR RESIDENTIAL BUILDING PERMIT • 1i D CERTIFICATE ANOF OCCUPANCY BUILDING INSPECTION DIVISION PERMIT INSTALLATION NO. EACH Plans Received By ....... .................. _.......___........... Date ......................... REQ.: Plans.... Survey.– Calcs: Struc..... Energy.... Elect..... Mach.... Plans Checked BY ___ ............................................. Date ..... ........ ..--- ...... Application Approved By ......................................... Date ......................... ValidatedBY.............................................................. Date ........................ Compensation Certificate Verified By ........... ..... Date ._.... ............ ..... in • . $ Dryer........ Garb. Disp......... Dishwasher _.._.............. Permit Fee (plus penalty if applicable) _....... ............... $_24_00-.. Plan Check Fee (less deposit of $..... .--- Rct. #..........) $........ ........ ..... Energy Plan Check Fee (Dep. of $........ Rct. #........) S ........ StrongMotion Fee ......................................................... $............r..2.. Plumbing Permit Fee ..... –.... .__....... _....._......_._..._$...... �.Q.:. .. Electrical Permit Fee ..... ....... ................. ..................... $.................._... Mach. Htg./Coolg. Permit $............................. $... ...... __.......... . Residential Construction Tax ................ ............... ..._.... $........._........_.. Misc. Fee........................................................................ Misc. (see Ord. current 1...... Misc. Fee ... ......... ........ _...._........ _ $_........_...._..... Mist. (Sae Ord. Current)..SO.]dTp ...RS711,1. $ 24.50 ZONING EMENTS 4_.............._......_ Environmental Status: Exempt .... ._.... Other ........ Design Review Approval: Bldg. _......... . Site ..._...... Sign ... Use Zone .... –..... P.D. Conditions ........ ........._........_......_ - Codd. Use Permit #...... ..... Variance #...........- Parking Spaces............ ApprovedBy.... ................................ ._.......__..._.... Date ........................... lcroachment Permit..... ... ............. Grant of Easement ......... _...... ........ urb, Gutter, Sidewalk, Driveway: Replace.......... Repair......_... Sewer............ Conn. Fee $....... Water ..... ._........ Meter $._– .... .._... Agreement for Completion of Public Works Improvements .................. Plans Checked By...._.. Date._..... Approved By........ Date ......... PERMIT INSTALLATION NO. EACH (FEE Light Outlets............ Switches............ 1001-1250 28.60 2251-2500 42.00– ............ 2.00.............................. o ............ *** Fixtures............ Receptacles............ ......... . .00 ............... PermitFee...............................................$6.00 TOTAL NUMBER (less than 1000 watts) .......... $ .50 -- ............ Range ..... _. Cooking Unit........ Oven_ ... ...... .... ..... ...... . 2.00 .. ...... ___ Dryer........ Garb. Disp......... Dishwasher _.._.............. 2.00 .. .......... MOTORS: 1 HP or less . .......... .......__................... .. .....2.00 .. ......._... Greater than 1 HP not more than 5 HP ....... .... 3.50 .. ............ Temporary Power Pole or Service — 100 amp ..._.....5.00 .. ............ —200 amp ......700 3.50.. ........ TimeClock ... _..................._ ........... _ . ... _.. 1.50 ........ Misc. (see Ord. current 1...... Final - Electrical ................ ....._......._......._ New Residential Occupancies Flat Rate 0-500 sq. ft. $22.00 1501-1750 $34.50 501-750 24.60 1751-20000 37.50 .............................. NO. EACH 751-1000 26.00 2001-2250 39.60 .............................. Gas System with up to 5 outlets ....................... 1001-1250 28.60 2251-2500 42.00– ............ 2.00.............................. o ............ *** 1251-1500 32.00 2501-2750 49.50.0 ............................ ......... . .00 ............... PermitFee...............................................$6.00 Water System (Installation, Alt. or Repair)' ................ TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.[]) $ INSPECTION• -r Water Closet.... Water Heater.... Ld. Tray........... ......... - 4.00 . Forms / Foundation ............... .......__ I BY:......_ ....... Date:... PlumbingGround Work ......... _.......... i..._ .............._...._........ Wash. Mach..... Dishwasher.... Garb. Disp.......... ... Rough Electrical....._........_......_......__.�...._...... .._ ........ .......... _. .....__.._.._......_.. -c ame - Plumbing and Heating ........ Lawn Sprinkler Sys. $5.00 Ea. add sys. $2.00 ❑) $ 'Utation 8 Energy .... .... ... ...__........ Vacuum Breakers ................... ........................ 3.50.. as Test Test Interceptor........ Water Softener ........ .............................4.00. Temporary Power Gas /Elect. ...... .....'.._.._........._ Plumbing Piping without fixtures .......... _..... ..! Final - Electrical ................ ....._......._......._ Mist. (Sae Ord. Current)..SO.]dTp ...RS711,1. ......_......._.......... Final - Building / Mechanical ............._........ .... ._........ 4_.............._......_ _ Final -Design Review y Landscaping ..... ............................................ TOTAL PLUMBING PERMIT FEE (plus penalty if app. ❑) If10. Final –Public Works........................................................... PERMIT NUMBER I 1796 STREET ADDRESS OF PROJECT: .... _...101.Z6..Engli Sh..0ak. Way............. ..... ..... .._..._................. Legal Description: Tract 6551 Block .......... _ Lot -L.6 ............ Description of Work:p2rml.t. .....S01. 3.. . . . Y ..._............................... ..._....._._._...._.....__........_....... let Struct. Improvement on Parcel: Yes.... No ... Area of Bldg .............. Separate Structure ........... or Addition/Alteration to Exist, Bldg........... No. of Stories. .... Use of Building _........ ........ _............. ._....... ..... Valuation of Project: $...._.....__ ....... ._............. ..._.......... ........... .:_........... Owner:.._ .................. ..... O . Phone:......__.......... Contractor:...._........ BASHOMES_xINC..City Bus. Lic. # . Contractor's Address: ..... ....... Phone:.................... Contractor - Electrical: .. ­ ... ­ .......... City Business License ........ Phone: ....... ............ Plumbing:........ __... .......... City Business License #............ .. _.... Phone: .................... Heating and Cooling ... ... _... _.... ........ ___ ......... ....... _............ City Business License #..._............... Phone:.................... Architect/Designer:........... .... ........... ... ..__.... :.. _.... Phone:. .... ............ .. Engineer: _._... ......... _..... ...... ___ ..... ............ ___ ..... Phone:.................... Lender: . .. .... ....... .. . ..... ........ __ ....... ........... .. [-] Unknown . .. "I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the workman's compensation laws of California." SIGNATURE OF APPLICANT/OWNER....... ..... ...... ....... _......................... ....... — ...... ... DATE....................... . ..... 'I certify that as the applicant I am licensed Addlethe provisions of the Contractors License Law and further that my Licens. No.. ................... _... in Classification ....... .— ................... __ is in full force and effect: or ...... I certify fiat I am exempt from the "Licensed Required" provisions of the Contractors License Law. (State basis of exemption.) I hereby acknowledge that I have read this application and state that the above is correct and agrrse to comply with all City Ordinances and State Laws regulating building. I (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way acture against said City in consequence of the granting of this permit." SIGNATURF OF APPLICANT/CONTRACTOR.._...... ........ .._.... ................ r.._......... DATE ........ NOTE: When properly validated this form constitutes a Building Permit. This permit expires and becomes null and vold should work not be commenced within 120 days from validation date, or should authorized construction be suspended or abandoned for a period of 120 days eller work is commenced. rtHMll INSIALLATION NO. EACH FEE Gas System with up to 5 outlets ....................... ........ ..$4.00. ............. Each additional outlet ................................... ......... . .00 ............... to 30 ton/HP ..................... Water System (Installation, Alt. or Repair)' ................ 4.00 17.00.............Space Water Closet.... Water Heater.... Ld. Tray........... ......... - 4.00 . ............. Lavatory.... Shower Pan.... Bathtub.... Sink,, ....... ........ .. 3.00............... 3.00...............Commercial Wash. Mach..... Dishwasher.... Garb. Disp.......... .......... 3.00............... .l. Misc. (See Ord. Current...._..........................._.....�........ Sewer ........ _ _.._..._ _....... ..... 8.00 _........... .... $ 6.00 Lawn Sprinkler Sys. $5.00 Ea. add sys. $2.00 ❑) $ Vacuum Breakers ................... ........................ 3.50.. Interceptor........ Water Softener ........ .............................4.00. . Plumbing Piping without fixtures .......... _..... ..! ........... Mist. (Sae Ord. Current)..SO.]dTp ...RS711,1. ...........4.00. ..........4..Q ..... ... ......,-, Permit Fee ............. _. .. .... .... . . ................ .. ...........$ 8 00 TOTAL PLUMBING PERMIT FEE (plus penalty if app. ❑) If10. 00 Forced Air Unit .................. to 100M .........J ..... ........ -$ 6.00............... over100M ................... 10.00 .. ........... Comfort Cooling Unit–...to 3 ton/HP ................... .. 6.00..........._. to 15 ton/HP ................... 9.50.............. to 30 ton/HP ..................... 12.00 ............. to 50 ton/HP..... ........ 17.00.............Space .. Heater........ Wall Heater ................ 6.00,....,,,.,,.Flues ....... - other than above.............................I.. 3.00..............Vent Fan: Kitchen....._. Bath .................. 3.00...............Commercial _......`Ir.. Range Hood ........._......_........ 8.00.._,__,,,...__ .l. Misc. (See Ord. Current...._..........................._.....�........ ....... PermitFee _._ ....................._.................. ............ _........... .... $ 6.00 TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. ❑) $