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1708 (2)
N CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION Plana Received By ............. W.C7..........................., Date o/VA,,.... REC.: Plans.... Survey..., Calcs: Strut..... Energy.... Elect..... Mach.... I Plans Checked By ...._....................... ........... Date ...... _ .. bb.1� Application Approved By ..........� . L....! .............. Date „ZZ ,/7PD ValidatedBy ---........_ ...................... ........... ._.......... Compensation Certificate Verified By ...... . ......... Date .----..... . . Data /..Y... .. • $77, az" $ .50 ... - 1251-1500 Permit Fee (plus penalty if applicable) ....................... 2.00 .......�. Plan Check Fee (less deposit of $.......... Act. #..........) $....... Energy Plan Check Fee (Dep. of $........ Act. #........) $....... f �.a.. Strong Motion Fee .......................................................... $.......... Plumbing Permit Fee ................................................ $..T/i!iD • Electrical Permit Fee ...................................................... $.....JY{.1o.r.. Mach. Htg./Ceolg. Permit $............................. $-... e.C.,7,0-P.. Residential Construction Tax ........................................ $....................... Misc. Fee........................................................................ $. ...................... Misc. Fee........................................................................ $. ...................... • $,�63 r32 ............ ZONING REQUIREMENTS TimeClock ............. ..................................... _........ ...,..... Misc. (see Ore. current)...................................................... Environmental Status: Exempt............ Other ....................................... abandoned for a period of 120 days after work Is commenced. ' Design Review Approval: Bldg ............. Site ............ Sign ............ Use Zone ............ P.D. Conditions............................................................ 'FEE Cond. Use Permit #............ Variance #....... _... Parking Spaces............ ApprovedBy .......................................................... Date ........................... WORKSPUBLIC r Wash. Mach.,/. Dishwas ./Garb. Dep..../..... 3.00........((.•? moroachment Permit ....:................... Grant of Easement....................... curb, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... Sewer...... --- - Conn. Fee $..... _...... ... Water .............. _ Meter $..... ,......_., Agreement for Completion of Public Works Improvements .................. Plans Checked By........ Date. ...... Approved By........ Date .................... 1 M TV Eli. 0-500 sq. It. $22.00 1501-1750 $34.50 501-750 PERMIT INSTALLATION NO. EACH FEE 751-1000 Light Out .�p.... SwitcheS4,91.... Fixtures .. Receptacles........ 2001-225C 39,50 .............................. 1001-1250 TOA NUMBER (less than 1000 watts) .... .. .. $ .50 ... - 1251-1500 RanCooking Unit........ Oven..../ ............... ge./.,. 2.00 .......�. 40.50 .............................. City Bus' ass Li ense, #..... ......:... Phone'.. .................. Dryer..../. Garb. Disp.../... Dishwasher ./......... .. 2.00,. ....toi "I certify that in the performance of the work for which this permit is MOTORS: 1 HP or less .............................................. 2.00 .. ....�.r� "I certify that as the applicant I am license ode the pryy,visiou�ty f ty Greater than 1 HP not more than 5 HP .............. 3.50 .............. ..... I certify that I am exempt from the "Licensed Required" provisions 01 the Contractors License Law. (State basis of exemption.) Temporary Power Pole or Service — 100 amp ..........5.00 .............. building. I (We) agree to save, indemnify and keep harmless the City of Cupertino — 200 amp . __... 7.00 .. ............ NOTE: When properly validated this form eonstitu a Building permit. This TimeClock ............. ..................................... _........ ...,..... Misc. (see Ore. current)...................................................... 1.50............... abandoned for a period of 120 days after work Is commenced. APPLICATION FOR PLUMBING New Resltlential Occupancies Flat Rate NO. EACH 'FEE 1 M TV Eli. 0-500 sq. It. $22.00 1501-1750 $34.50 501-750 24.50 1751-20000 37.50 .............................. 751-1000 26.00 2001-225C 39,50 .............................. 1001-1250 28,60 2251-2500 42.00 .............................. 1251-1500 32.00 2501-2750 40.50 .............................. City Bus' ass Li ense, #..... ......:... Phone'.. .................. Permit Fee...............................................$6.00 L er:... .............. .. E3 Unknown TOTAL ELECTRICAL PERMIT FEE•(Plus penalty If app.p) $� 6 11p Forms / Foundation ................. B u�..... Plumbing 6•etarb& lS7k 1111,01.4--1 ... .�........ Test T.amOn P •• �.•• MD. . vu....... Final -Electrical .. ....... __......... .._._....._. _(A....�/S..:Sc L....... Final - Building / Mechanical .............. /p,ll......... .... . .......... Final - Design Review / Landscaping . ........................� ........ h Final -Public Works ..C...�......+ ............................... ... .. ...••FV •3 -fti -�, w e r N e PERMIT NUMBER ,7d g •• APPLICANT TO FILL IN )u./saPJ JqCT: .i l?✓ 4 ........................................................ Legal Description: .................) .... Blork........... Lot....T ............. Descriptiogf Work ✓!�i.A.....r`t.nrif, 777Tract .. ............................. ��c f,"h.©.u.S................................................................ 1st Struct. Improvement on Parcel: Yes.... No ... Area of Bldg ............... Separate Structure........... or Addition/Alter tion t9 Exist. Bldg.......... No. of Stories....2,.,... Use ��LL Build Ing dZ-. i.r n:.- ...... Valuation of Pro] ct: $....._i-ci.:. ............................._........... Owner . t✓Py.�y. Phone :.................... Contractor: ��yj.. .. .. C✓,'../. Citi Bus. Lic. x _..._...... Contractor's Adores :3, �%5i.�v/l( :. PhonEf;? �.f! Contractor - Electrical: ....... ......... _ .............................. City Business License #.................... Phone:.................... Plumbing: ..... __ ...... ...... .......... ........... __ .... .............. City Business License #...-. .............. Phone:.................... Heating and Cooling ...... ................._.._._....... ............... ......... City Bus' ass Li ense, #..... ......:... Phone'.. .................. Architect/Dem:.-ijl •— Engineer: % .. ........... Phone32.- .. L er:... .............. .. E3 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 compo anon sof If SIGNATURE OF AP ANT/OWNER •�•'... DATE/ "I certify that as the applicant I am license ode the pryy,visiou�ty f ty Contractors License Lew and lurcher that y Le. No.'3C1v53L. In Classification ..... ....... .... _.... . ..... Is in full force and effect: or ..... I certify that I am exempt from the "Licensed Required" provisions 01 the Contractors License Law. (State basis of exemption.) I hereby acknowledge that I have read this application and state that the above Is :arrect and agree 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 exp e w is may In any way acture against said City In co ague a of this permit" SIGNATURE. OF q� qq�� APPLICANT/CONTRALTO ... ...., DATE Pp,tecn0 NOTE: When properly validated this form eonstitu a Building permit. This permit expires and becomes null and void should work not be commented within 120 days from validation date, or should authorized conslrucaon be suspended or abandoned for a period of 120 days after work Is commenced. APPLICATION FOR PLUMBING PERMIT INSTALLATION NO. EACH 'FEE Gas System with up to 5 outlets ...............................$4.00.. -.. .,,..� Each additional outlet .................................. ... 1.00. ...... .fib., Water Systertyjlnstallation, Alt. or Repairj ....... .. 1... .. 4.00....... Water Clgget:� Water Heater.l Ld. Tray ............. ... .. 4.00. � .-r.,,.,. Lavatory,'..'Shower Pan.l. Bathtub -Z Sink -e-..... ... .. 3,00. Q-A Wash. Mach.,/. Dishwas ./Garb. Dep..../..... 3.00........((.•? Sewer.........�o..9.SV........................................ .... ... .. B.00......1/37� Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00 .................... ............. Vacuum Breakers ............................................ ..............3.50.............. Interceptor........ Water Softener ........ ..... ........................4,00. :..,..,,,,,, Plumbing Piping without fixtures ...................................4.00............... MISC. (See Ord. Current) .................................................... PermitFee ...................................................................$ e.00 TOTAL PLUMBING PERMIT FEE (plus penalty if app. C)) = 0 APPLICATION•• HEATINGICOOL PERMIT INSTALLATION I NO. 11111 FEE Forced Air Unit .................. to 100M ..................... ., .,,,..$ 5.00.,. .(Q...., 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...................................11 6.00.. Flues - other than above 7r..`.. 3000 ........... .. ..�L..... Vent Fan: Kitchen........ Bath .... .... ... .. 3.00......c2 e.00 ............... Commercial Range Hood /.. r Misc. (See Ord. Current........................................................................... PermitFee .......... ..................... -.............. - ... ...... ............ $ 6.00 TO AL Htg./ Coolg. Permitee (plus penalty if app. ❑) $�7r 4 t 14