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1838CITY OF CUPERTINO CITY OF -,APPLICATION FOR RESIDENTIAL BUILDING PERWAN AND CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION F Plans Received By .................................................... Date ......................... REO.: Plena.:.. Survey.... Celts: Struc..... Energy.... Elect..... Mach.... Plana Checked By.. .................................................. Date ......................... Application Approved By ......................................... Date ......................... ValidatedBy.............................................................. Date ........................ Compensation Certificate Verified By ................. Date ............. Permit Fee (plus penalty if applicable) ........................ $ ....................... Plan Check Fee (less deposit of $.......... Rct. #..........I $....................... Energy Plan Check Fee (Dep. of $........ Rot. #........) $....................... StrongMotion Fee .......................................................... $....................... Plumbing Permit Fee................................................$..�..�?..r...Q ElectricalPermit Fee ...................................................... $ ....................... Mach. Htg./Coolg. Permit $............................. $ ....................... Residential Construction Tax ........................................ $ ....................... Misc. Fee ............................................ :........................... 5.........---........... Misc. Fee........................................................................ $. ...................... . $ Environmental Status: Exempt............ Other ........................................ Design Review Approval: Bldg ............. Site Sign . Use Zone ............ P.D. Conditions ................... Co1id. Use Permit #.......:.... Variance #............ Parking Spaces............ ApprovedBy ........................................................... Date ........................... achment Permit ........................ Grant of Easement........................ Gutter, Sidewalk, Driveway: Replace.......... Repair.......... '............ Conn. Fee $................ Water................ Meter $ ................ ment for Completion of Public Works Improvements .................. Checked By........ Date........ Approved By........ Date .................... CUPERTINO 41 2 D W1 PERMIT NUMBER I / S Legal Description: Tract ........................ Block............ Lot...................... Descriptio of Work: .../1V .7744L(��70N....(� ...4VA7..�e..... .................�IWI1 ZI..el.......................................................__...................... 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: ..... -7 a6"W0iV....................................... Phone:'?N9`%-.. ..+kQ Contractor:. Hd F.DEFH4 120_ .......... City Bus. Lic. OF .............. Contractor's Address:. Q9. ... A-LA.Ao_ Phone JRJ7! » Contractor - Electrical:........... LLT>7 City Business License #.................... Phone:.................... Plumbing: .... .................................................................................. City Business License #.................... Phone:.................... Heatingand Cooling.................................................................. City Business License 0 .................... Phone:.................... Architect/Designer:.................................................. Phone:...................: Engineer: ...... ........ ............................. __ ........... .. Phone:.................... Lender: . ... .......... ... ___ .................................. .................. .. p Unknown .. .. ... "1 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 lw of California." / SIGNATURE OF APPSICANT/OWNER .. ... .. ........... .. DATE. -.........-.I........ ......... "I certify that as the applicant 1 am lico ed unde• the pro lops of jlhe Contractors License L99,,w and further shat my Llcens. No...rr.LL.Y(a.9.Y... in Classification ..... ...[„'.9b................ Is in full force and effect: or ....... .. I certify that I am exempt from the "Licensed Required" provisions of the Contractors License Law. (Stale basis of exemption.) - I hereby acknowledge that I have read this application and stale that the above Is <orrecl and agree to comply with all City Ordinances and Slate Laws regulating building. ' I (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costa and expenses which may in any way acture against sold City In consequence of the granting of thispperrmit." SIGNATURE OF �L _ / _ ...._ _.._. DATE `• /. APPLICANT/CONT RACTORJCLLLPR,._........ �,,,,,,, NOTE: When properly validated this form consul s a Building Permit. This permit expires and becomes null and void should work notbe commenced within 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 IFEE Light Outlets............ Switches............ APPLICATION FORPLUMBING 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 Heated. Ld. Tray................... 4.00. � 0.�. 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. Diap..... ..... ........ .. 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 1 ...................................................... Vacuum Breakers ..............._........................... ..............3.50.............. New Residential Occupancies Flet Rete Interceptor........ Water Softener...................................:.4,00. ............ 0-500 sq. ft. $22.00 1501-1750 $34.50 Plumbing Piping without fixtures ...................................4.00............... .............................. 501-750 24.50 1751-•20000 37.50 Misc (See Ord. Current) .......................... ........................• .............................. 761-1000 26.00 2001-2250 39.50 Permit Fee .......................................................................... $6.00 .............................. 1001-1250 28.50 2251-2500 42.00 .............................. TOTAL PLUMBING PERMIT FEE (plus penalty If app. E]) $ /0.00 1251-1600 32.00 2501-2750 49.50 .................. :........... APPLICATION Permit Fee...............................................$e.o0 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.p) $ PERMIT INSTALLATION N0. EACH FEE ForcedAir Unit .................. to 100M ..............................g 9.00............... INS • •RECORD over I OOM ....................... .10.00 ............. Forms / Foundation .:........ ................... By:................ Date:................ Comfort Cooling Unit...... to 3 ton/HP ................. .......... 6.00,.............. Plumbing Ground Work (..... to 15 ton/HP................. ........ 9.50.............. . ._ .............._ .....................I..................... Rough Electrical ... �... I ........._in to 30 ton/HP ........................ . . 12.00. . .......... ...,.._ ...... .,' e - Plumbingand Heating 1 .................................................... 9 .......... 6 Ener 9Y........................................................�........................... Heater../HP................. Space Heater..hen Wall Heeler ........................... .........17.00.. ........... ........ 8.00.. ........... Test r Teat Flues -other then above ...........................:......... .......�.. 3.00.............. ............. .....................................................!... orary Power Gas / Elect ............. .......... Vent Fan: Kitchen........ Bath ............................... .......... 3.00.....:......... . ................................. "incl - Electrical ........................... Commercial Range Hood ................................... 6.00.,. ......... ............ ........................................................................................ In nal - ng /Mechanical Misc. (See Ord. Current........................................ ........ .... ..... ............ ..:_............................................................. I - Design Review / Landscaping Permit Fee ... $ $ 6.00 ............................. l- Public Works ...................... ........................ ..................... TOTAL Ht /Cool Permit Fee jus anal 9• 9• (P penalty I e PP• O) $