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1676 EC PERMIT NUMBER D;7=22 FOR APPLICANT TO FILL IN 'Mi, MEMO, STREET ADDRESS OF PROJECT:,? ............................... .............. ..­ Plans Received By......._...........................................Date ......................... Legal Description: Tract. ...,Block............ Lot....---............... ot..................... RED.: Plans._ Survey.... CaIcs: Struc....- Energy.... Elect..... Mach.... Description of Work: ....Sv; ................... ..................... Plans Checked By..... .....................................Date ......................... 1st Struct. Improvement on Parcel:Yes.... No.... Area of Bldg............... . 4X Application Approved By....... . ��........__............Date Separate Structure............ or Addition/Alteration to Exist. Bldg........... ValidatedBy.............................................................Date ............._........ No. of Stories................ Use of Building ................................................ Compensation Certificate Verified By....................Date ......................... ValuatioU Pro ct: $...31^_1�&V $ L, 4 r , ­............*... .. ........... ....... ..... Phone:..................... -Contracto I Bus.Lic.#............. It Address:9­3 ......... V�_. C.A............... Phoe .wr�or�*._ Permit Fee (plus penalty if applicable) ........................$..... V.... i Plan Check Fee (less deposit of$.......... Rct. #_........)s... Contractor - Electrical: ................................................... .................. Energy Plan Check Fee (Dep. of $........ Rct. #.--.....)$__ . ..... City Business License #.................... Phone:.....--.-...-.......' ' StrongMotion Fee .................................. ... ...........$..........±.5d.... Plumbing: ................................................................................ Plumbing Permit Fee ......__.....................................$........--..........._ City Business License #.................... Phone:.................... Electrical Permit Fee .................................................._$....................... Heating and Cooling ..........#............................... . ................,....... Mach. Ht /Cool Permit $ .............................. .............._--- City Business License ................... Phone:.................... Construction Tax.............................................$..........--........... Architect/Desi ner: ...........................__................. Phone:.................... Sewer Conn. Fee ...!......... Water Conn. Fee ....._-----_$............-..---._- Engineer: ........__.......... ............................................ Phone:............. Landscape Fee .................... Street Tree Fee ............$............-.......... Lender: ................_.................................................................0....j2n.agn Misc. Fee .........................................Ah,111..............$ ........ -,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 o the workman's compensation laws of California." Type Const......... Group........ Div......... Occ. Load........ No. Exits......-- SIGNATURE OF I Floor Loads; 1st.... 2nd.... Other.... Sprinklered...- Area Sep. Walls.... APPLICANT/OWNER ......................... .....................................DATE ............................ ZONING REQUIREMENTS ............ I certify that as the applicant I am licensed under the provisions of the Contractors License Law and further that my License No. ........................... Environmental Status: Exempt............ Other ........... in Classification ........................................ Is In full force and effect: or ............ I certify that I am exempt from the "Licensed Req, ad" provisions of the Design Review Approval: Bldg. ............ Site ............ Sign ------------ Contractors License Law. (State basis of exemption., Use Zone ............ P.D. Conditions ............................................................ I hereby acknowledge that I have read this application and state that the above Is Cond. Use Permit#......Variance #...... Parking Spaces.... Load. Sp..... correct and agree to comply with all City Ordinances and State Lam regulating Approved By........................................................... Date ---...................... building. ,elwe) agree to save, indemnity and keep harmless the City of Cupertino • against liabilities, judgments, costs and expenses which may in any way acture against said City I cc equence f the granting of this permit. achment Permit.........._............ Grant of Easement........................ SIGNATURE OF %bo Sidewalk,. wReplace Repair Gutter, Sidewa .Driveay: APPLICANT/CONTRACTO; , Sewer----------.- Conn. Fee $................ Water................ Meter$............... NOTE: When property validated this Iona constitutes a Bulking Panels. Thle Agreement for Completion of Public Works Improvements .................. permit expires and becomes null and void should work not be commenced *110in Plans Checked By........ Date........ Approved By........ Date.................... 120 days from validation daft, or should authorized construction be suspended or abandoned for a period of 120 days after work Is commenced. APPLICATION FOR ELECTRICAL PERMIT APPLICATION FOR PLUMBING PERMIT PERMIT INSTALLATION NO. EACH FEE Light Outlets............ Switches....--...... PERMIT INSTALLATION NO. EACH I FEE Fixtures.........--- Receptacles............ Gas Sytem with up to 5 outlets ................................... $4.00 .....:... TOTALINUMBER(lessthan 1000watts)................. $ .5o . ...... .... Each additional outlet ............................................ 1.00,.............. Range........Cooking Unit........ Oven........... ................. 2.00 ............... Water System (Installation, Alt. or Repair) ................ 4.00 .............. Dryer..--Garb. Disp..... Dishwasher-_ ........ ................. 2.00 ............... Water Closet.... Water Heater.... Ld. Tray.................... 4.00. ............ SERVICE OR TEMPORARY POWER to ................. 2.00 1......... Lavatory.... Shower Pan.... Bathtub.... Sink.................. 3.00_�.......... 100 amp/$5.00, 200/$7.00,.500/$9.00 Wash. Mach..... Dishwasher.... Garb. Disp..... .............. 3.00 .............. 800/$20.00, 1200/$40.00 .................................. ............................... Sewer ­........ 8.00 .............. MOTORS,Generators,Welders,Heaters, Lawn Sprinkler Sys. $6.00 Ea. add Sys. $2.00„---,-,............... ............. per HP-KW-KVA to 1/$2.00, 5/$3.50, Vacuum Breakers reakers ....................................... ... ::: ' :�::......20/$6.60, 50/$10.00, 100/$12.00, Slop Sink........ Floor Sink-------- Floor Drain --- . : .. - 500/1116.00 ............................................................ ............................... Urinal.... Interceptor.... Water Softener.... ......-... ­ 4.00 1 Signs with I XFMA ...................................... ................ 2.00 . ...... .... Plumbing Piping without fixtures ........... ......... 4.00 Each additional XFMA/Time Clock .. ........ .50 .. . ......... .. Misc. ........................................................... 7 . .. ................. Annual Electrical Maintenance ............. ...25.00 .. _.._.W.. Permit Fee .................................. ...................111 6.00 Other (see Ordinance Current) .................. ............................. ............. TOTAL PLUMBING PERMIT FEE (plus penalty If app. C]) III .............................................. ............................. APPLICATION FOR HEATING/COOLING PERMIT ......................................................................... ............ .......... ............ Permit Fee ........................................................................ $ 6.00 Q7 PERMIT INSTALLATION NO. EACH FEE TOTAL ELECTRICAL PERMIT FEE(plus penalty if app.[:)) $ Forced Air Unit...............to 100M ................................. $ 6.00 ............ INSPECTION RECORD n over LOOM .................... ......... 10.00 ............... Comfort Cooling Unit.....to 3 Ion/HP................. ........... 6.00 ............... Forms / Foundation............................... By:.................. Date:................\ to 15 ton/HP................ ........... 9.50 . m I Plumbing Ground Work ........................ ............................................ to 30 ton/HP..........................12.00 ................ ^iugh Electrical ..................................... ............. to 50 Ion/HP........................ 17.00 .............. a - jl; L ..........1-141p..............{.-.7:. Space Heater........ Wall Heater .......................... I...........8.00 ........... ation / Energy...............;.............. ............................................... . Flues - other than above .................................... ............3.00 .............7 WS]Test ................................................................................................ Vent Fan: Kitchen........ Bath ..........................................3-00 ............... Temporary Power Gas /Elect...................................................._....I Commercial Range Hood ............................................. 6.00 ............... Final - Electrical ....................................................................................... Misc. .............................................................................­1............................ Final - Building/ Mechanical .................................................................. Permit Fee ........................................................................$ 6.00 Final - Design Review / Landscaping I........................I.......................... TOTAL Htg./ Coo1g. Permit Fee (plus penalty if app. 0) S Final - Public Works...........................................................