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1369CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION Plans Received By .................................................... Date ........................ REQ.: Plans.... Survey.... Calcs: Struc ..... Energy.... Elect..... Mach.... Plans Checked By ............... Lx!0'-'J .. ................... Date --- Application Approved By .....17...4 ................... Date �.7 ValidatedBy .............................................................. Date ........................ Compensation Certificate Verified By ................. Date ... __ .................. $ ;COU czp, Permit Fee (plus penalty if applicable) ........................ Plan Check Fee (less deposit of $.......... Rct. #..........) $ ....................... Energy Plan Check Fee (Dep. of $.....,._ Rct. # ........) $ ....................... Strong Motion Fee ......... ...................... .. . ... $.............5-7). S-7). Plumbing Permit Fee .................. .................. ....... ...................... Electrical Permit Fee ...........................i: .... ... ....................... Mach. Htg./Coolg. Permit $ ............................. $....................... Residential Construction Tax .............. .............. ........... $ ....................... Misc. Fee.................. . ........... .. .... . ....'t . ..... ............... Misc. Fee ..................................Ai4A....... $......6.. Environmental Status: Exempt ............ Other ........................................ Design Review Approval: Bldg. .- ........ Site ............ Sign ............ Use Zone ............ P.D. Conditions ............................................................ Cord. Use Permit e............ Variance N............ Parking Spaces............ ApprovedBy ........................................................... Date ........................... '11IF7achment.Permit ........................ Grant of Easement........................ Gutter, Side Gutter, Sidewalk, Driveway: Replace.......... Repair.......... a r . ........ Conn. r ............ Conn. Fee $ ................ Water................ Meter $................ ,iAgreement for Completion of Public Works Improvements .................. Pieria Checked By........ Date........ Approved By........ Date .................... PERMIT INSTALLATION NO. EACH IEEE Light Outlets............ Switches............ Fixtures............ Receptacles............ TOTAL NUMBER (less than 1000 wells) ............ $ .50 . . ..... Range........ Cooking Unit........ Oven ............ ......... ...... 2.00 .............. Dryer........ Garb. Disp ......... Dishwasher .............1....... 2.00 .............. MOTORS: 1 HP or less ............................. ... Greater than I HP not more than 5 1­11P'�� 32:5000 J::�*** *...'. Temporary Power Pole or Service - 100 amp ..........5.00 .. ....... - 200 amp. 7.00 ............... Time Clock ............................... .... ................ I ... ... . 1.60 ... ......... - Misc. (see Ord. current................................... New Residential u .Pa 1. 9tti-t-Tt%� 0-600 sq. ft. $22.00 1501-1750 $34.50 ........................... 501-760 24.50 17511-20000 37.50 ........................... 751-1000 26.00 2001-2260 39.50 ........................... 1001-1250 28.50 2251-2500 42.00 .............................. 1251-1500 32.00 2501-2750 49.50 .............................. PermitFee ...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (plus penalty if app.0) $ Forms / Foundation ............... ............I By:................ Date:........,....... Plumbing Ground Work . .... ........ ...... ..... ... _ ...................... IT Electrical ...................... . .. ...... .................. a - Plumbing and Heating ................ ........................ ation & Energy. . ..... ...... . . .. . . .......... . #, Test ............. Temporary Power Gas Elscto .................... Final - Electrical . ........... I ...... .................. Final - Building / Me�han I ...... ...... ........... Final - Design Review Y Landscaping . ........ _ ...... . ... __ .......... Final -Publo Works ........................................................... PERMIT NUMBER FOR APPLICANT TO FILL IN STREET ADDRES 0 P OJEC : ......................... Legal Description: Tract..r+.41tock ............ Lot...................... Description of Work- ................. .......... ....... .......... . .. ... .... . ... ... ................... .......... ............................. 1st Struct. Improvement on ptri Yes.... No... Area of Bldg ............... Separate Structure..........., or Addition/ Alteration to Exist. Bldg........... No. of Stories ................ Use of Build'n Valuat I Proley: $SOU 'or . ..... a :1;s6 Phone: Owner' YOVIC ... d'.2 Contractor: ...... ... - .................t' ...... ........ ... _4 ..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 at the work for which this permit 15 issued I shall not employ any person In any manner so as to become subject to the workman', compensation laws at Cattle r SIGNATURE OF F APPLICANT/OWNS T/71d, DATE -174:74P t "I certify that as the applicant I am licensed u de the provisions of the Contractors License Law and further that my LIcens, No. ... ......................... in Classification ..... ..... ___ ....... .............. is In full force and affect: or I certify that 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 •.orrect and agree to comply with all City Ordinances and State Laws regulating latidtfing. 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." SIGNATURE OF APPLICANT/CONTRACTOR ................ _ ...... - ................................. DATE ........................ NOTE: When properly validated this farm constitutes a Building Permit. This permit expires and becomes null and void should work not be commenced within 12:ndays,drfo,m rdclion be susperalked or so per, r validation date, or should authorized const period of 120 days after work is commenced. APPLICATION FOR PLUMBING PERMIT PERMIT INSTALLATION NO. IMT -F=E Gas System with up to 5 outlets ....................... ........ .. $4.00. ............. Each additional outlet ............................. ........ .. 1.00............... Water System (installation, Alt. or Repair) ... ... ........ .. 4.00 . .............. Water Closet.... Water Heater.... Ld. Tray .......... ........ .. 4.00 . ............. Lavatory.... Shower Pan.... Bathtub.... Sink ........ ........ .. 3.00 .............. Wash. Mach..... Dishwasher.... Garb. Disp ..... ..... ........ .. 3.00............... Sewer..................................................................... ........ .. 8.00 . .............. Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00 .................................. Vacuum Breakers ........................................ 3 ' Interceptor........ Water Softener ........ .............................4.00............. 0 Plumbing Piping without fixtures ....................... ........ .... 4.00 . .............. Misc. (See Ord. Current) ......................... I ...... I .......... I .......... PermitFee .......................................................................... $6.00 TOTAL PLUMBING PERMIT FEE (plus penalty If app. 0) $ I APPLICATION FOR HEATING/COOLING PERMIT PERMIT INSTALLATION NO. EACH FEE ForcedAir Unit .................. to 100M ..............................$ � -$ 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 ....................... 3.00 3.00............... Commercial Range Hood ........ .. 6.00............... Misc. (See Ord. Current ....... .. ............ ............ Vent Fan: Kitchen........ Batt PermitFee ........................................................................ $ 6.00 TOTAL Htg./ Coo1g. Permit Fee (plus penalty If app. 0) $ 3; CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION Plans Received By .................................................... Date ........................ REQ.: Plans.... Survey.... Calcs: Struc ..... Energy.... Elect..... Mach.... Plans Checked By ............... Lx!0'-'J .. ................... Date --- Application Approved By .....17...4 ................... Date �.7 ValidatedBy .............................................................. Date ........................ Compensation Certificate Verified By ................. Date ... __ .................. $ ;COU czp, Permit Fee (plus penalty if applicable) ........................ Plan Check Fee (less deposit of $.......... Rct. #..........) $ ....................... Energy Plan Check Fee (Dep. of $.....,._ Rct. # ........) $ ....................... Strong Motion Fee ......... ...................... .. . ... $.............5-7). S-7). Plumbing Permit Fee .................. .................. ....... ...................... Electrical Permit Fee ...........................i: .... ... ....................... Mach. Htg./Coolg. Permit $ ............................. $....................... Residential Construction Tax .............. .............. ........... $ ....................... Misc. Fee.................. . ........... .. .... . ....'t . ..... ............... Misc. Fee ..................................Ai4A....... $......6.. Environmental Status: Exempt ............ Other ........................................ Design Review Approval: Bldg. .- ........ Site ............ Sign ............ Use Zone ............ P.D. Conditions ............................................................ Cord. Use Permit e............ Variance N............ Parking Spaces............ ApprovedBy ........................................................... Date ........................... '11IF7achment.Permit ........................ Grant of Easement........................ Gutter, Side Gutter, Sidewalk, Driveway: Replace.......... Repair.......... a r . ........ Conn. r ............ Conn. Fee $ ................ Water................ Meter $................ ,iAgreement for Completion of Public Works Improvements .................. Pieria Checked By........ Date........ Approved By........ Date .................... PERMIT INSTALLATION NO. EACH IEEE Light Outlets............ Switches............ Fixtures............ Receptacles............ TOTAL NUMBER (less than 1000 wells) ............ $ .50 . . ..... Range........ Cooking Unit........ Oven ............ ......... ...... 2.00 .............. Dryer........ Garb. Disp ......... Dishwasher .............1....... 2.00 .............. MOTORS: 1 HP or less ............................. ... Greater than I HP not more than 5 1­11P'�� 32:5000 J::�*** *...'. Temporary Power Pole or Service - 100 amp ..........5.00 .. ....... - 200 amp. 7.00 ............... Time Clock ............................... .... ................ I ... ... . 1.60 ... ......... - Misc. (see Ord. current................................... New Residential u .Pa 1. 9tti-t-Tt%� 0-600 sq. ft. $22.00 1501-1750 $34.50 ........................... 501-760 24.50 17511-20000 37.50 ........................... 751-1000 26.00 2001-2260 39.50 ........................... 1001-1250 28.50 2251-2500 42.00 .............................. 1251-1500 32.00 2501-2750 49.50 .............................. PermitFee ...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (plus penalty if app.0) $ Forms / Foundation ............... ............I By:................ Date:........,....... Plumbing Ground Work . .... ........ ...... ..... ... _ ...................... IT Electrical ...................... . .. ...... .................. a - Plumbing and Heating ................ ........................ ation & Energy. . ..... ...... . . .. . . .......... . #, Test ............. Temporary Power Gas Elscto .................... Final - Electrical . ........... I ...... .................. Final - Building / Me�han I ...... ...... ........... Final - Design Review Y Landscaping . ........ _ ...... . ... __ .......... Final -Publo Works ........................................................... PERMIT NUMBER FOR APPLICANT TO FILL IN STREET ADDRES 0 P OJEC : ......................... Legal Description: Tract..r+.41tock ............ Lot...................... Description of Work- ................. .......... ....... .......... . .. ... .... . ... ... ................... .......... ............................. 1st Struct. Improvement on ptri Yes.... No... Area of Bldg ............... Separate Structure..........., or Addition/ Alteration to Exist. Bldg........... No. of Stories ................ Use of Build'n Valuat I Proley: $SOU 'or . ..... a :1;s6 Phone: Owner' YOVIC ... d'.2 Contractor: ...... ... - .................t' ...... ........ ... _4 ..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 at the work for which this permit 15 issued I shall not employ any person In any manner so as to become subject to the workman', compensation laws at Cattle r SIGNATURE OF F APPLICANT/OWNS T/71d, DATE -174:74P t "I certify that as the applicant I am licensed u de the provisions of the Contractors License Law and further that my LIcens, No. ... ......................... in Classification ..... ..... ___ ....... .............. is In full force and affect: or I certify that 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 •.orrect and agree to comply with all City Ordinances and State Laws regulating latidtfing. 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." SIGNATURE OF APPLICANT/CONTRACTOR ................ _ ...... - ................................. DATE ........................ NOTE: When properly validated this farm constitutes a Building Permit. This permit expires and becomes null and void should work not be commenced within 12:ndays,drfo,m rdclion be susperalked or so per, r validation date, or should authorized const period of 120 days after work is commenced. APPLICATION FOR PLUMBING PERMIT PERMIT INSTALLATION NO. IMT -F=E Gas System with up to 5 outlets ....................... ........ .. $4.00. ............. Each additional outlet ............................. ........ .. 1.00............... Water System (installation, Alt. or Repair) ... ... ........ .. 4.00 . .............. Water Closet.... Water Heater.... Ld. Tray .......... ........ .. 4.00 . ............. Lavatory.... Shower Pan.... Bathtub.... Sink ........ ........ .. 3.00 .............. Wash. Mach..... Dishwasher.... Garb. Disp ..... ..... ........ .. 3.00............... Sewer..................................................................... ........ .. 8.00 . .............. Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00 .................................. Vacuum Breakers ........................................ 3 ' Interceptor........ Water Softener ........ .............................4.00............. 0 Plumbing Piping without fixtures ....................... ........ .... 4.00 . .............. Misc. (See Ord. Current) ......................... I ...... I .......... I .......... PermitFee .......................................................................... $6.00 TOTAL PLUMBING PERMIT FEE (plus penalty If app. 0) $ I APPLICATION FOR HEATING/COOLING PERMIT PERMIT INSTALLATION NO. EACH FEE ForcedAir Unit .................. to 100M ..............................$ � -$ 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 ....................... 3.00 3.00............... Commercial Range Hood ........ .. 6.00............... Misc. (See Ord. Current ....... .. ............ ............ Vent Fan: Kitchen........ Batt PermitFee ........................................................................ $ 6.00 TOTAL Htg./ Coo1g. Permit Fee (plus penalty If app. 0) $ 3;