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03030025CITY OF CUPESIO NO p ? i o <that .. S ► > 0 Z Q F U py m ..; Co1V'CRA�i'U 3Y N i �,�y � � = BUILDING DIVISION PERMIT „a.:, .. BUILDING ADDRESS: ...... ERM. N003030025 ER'S NAME: PERM. Esff�16 / 2 0 0 3 G LEVER AND NINA TRUSTEE HE: SANITARY NO. CONTROL NO. ARCHITECffENOINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MWH O O O 0 TOR DECLARATION LICENSED CONTRACnOR'SDEConsofCON licensedCONTRACTORS 1 Mosby Na11 of Chapter 9 (commencing P JobDescri tt����p affloonLIC w with Section Tarp) of Divisitn 3 of he Business and Professions Coda, orb my Becnse is �a �® in full force and cfraL ADD 693 SQ. FT. /REMODEL License Class l.ic.1 Dam Contractor APR 0'6 2004 ARCHREM DECLARATION I mince and my plans "I be used a public records BUILDING Licensed Professional OWNER -BUILDER DECLARATION vera 1 Wreso .(Bens that 11. cousin from the ConteaelCo License Law rm Ne ng moon. 7 B. alter and Professions Code: Any city m county re cores alcor, Improve, demolish, or repair any structure which (emit i construct. which coquina t pear LL1 d3 ensedpursuant In the prevision of rm such permit la clam Lle a a statement issuance, &to the is pursuant mold (ChaptersCode) and Sq. Ft. Floor Area $300 P@hon Prollaw them Code) of of Divionamthe Business (como ncing with Seaton] Division mmen $ musuplh alleged exe pt on. An vi sties W la exempt therefrom and Ne thou fm the Wcged exemption. Any violation of drum and the Im 3 Ef�EIB�Qlri berO 0 Occupancy Type Section 7031.5 by any applicant for a permit subjects Ne applicant m a civil penally of not more Nan five hundred dollars (5300). D 1, u ownerof Ne pmpaty, umy employe with wage a them sole ampenution, — d Inspections will do the work and theatruclule is notlnmaded uoRered lorame(Sec. 7044, Busircu and ProfenlON Coda: The Cootraoule License Law does amt apply m se ownsr of 102 - PIERS P property who builds m impr o m Nareon, sed who does soh work himsel f er through his awnemploy s, provided that such improvements artnotimudedmannedfusels,B, 103 — UFER however. the building er impmwnent u said within one year ofcumpletion, the ownec- Wilder will have the burden of proving Ilut W did Out Wild m improve for purpose of 104 — REBAR "" 105 ANCHOR BOLTS 1, us owner of the property, am exclusively contracting with licensed conuamma m _ 106 SEWER & WATER coMruct the project (Sec. 7046. Business sed Profusions Code:) The Contncwr's U. ane law dace not apply m an owner of property who Wilda or Improves Nemon, and, 202 — UNDERFLOOR PLUMBING who contracts for such projects with aconlracutt(G licensed pursuant to the Cantraclars License Law. 203 - UNDERFLOOR MECHANICAL Dlamexemplu Sec. ,BkPCfuthis renson 204 - UNDERFLOOR FRAME D.m 205 - 301 - UNDERFLOOR INSULATION ROUGH PLUMBING WORKER'S COM ATION D ATION 2 I hereby amrm under penalty or perjury one following deelaeaeons: 302 — TUB & OR SHOWER ❑ I lass and will maintain a Certificate of Comanl loselr-Insure forworYeYa Compen. Orion, u pmvlded her by Section 3700 of the lather Code, for due performance of the 303 - ROUGH MECHANICAL wertrorwhichthisPermitisioma 304 - ROUGH ELECTRICAL Laialwr Coode, or tin parvenu by Section OOD of 305 — FRAME to, p�mrorm�eor�weowtreasonous, theve lc rat orrl l� My W, minces Compensation Insurance Carrier and Policy number am: 306 — HOLDOWNS Carer. Policy No.: 307 - INSULATION CERTIFICATE COMPENSATION INSURANCEORKERS' 308 — SHEETROCK ' (Dllasection rcadno, Wcampkmd dust permit Is rare= hundred doilan(SIM) 309 - EXTERIOR LATH orless.) 310 - INTERIOR LATH 1 eenify Net in N r rmance of the work for which this peemh Is snood, l shall not 311 - SCRATCH COAT employ any pc on in ymanpttwSVW Wamc subjgcl to em Workcra'Compensation la sof plus a 3 IAA ( 313 - ROOF NAIL A 1 501 - FINAL ELECTRICAL ENERGY N ETOAP .aRermeti IsCeniOeemolPaemplion,yo ould become subject re the Workers Compensation provisions of the lahu Code, you most forthwith comply with such provisions m Nu permit Nall W doomed revoked. 502 - FINAL PLUMBING ENERGY 503 - FINAL MECHANICAL ENERGY Nn Net e i,aemauumonlending for the perfmmancc of Cat them Inor 504 — . FINAL BUILDING ENERGY whichthi C.) NcwneNarm, Nu pennituucaa(sa.3D9.cI.c.) 505 - FINAL ELECTRICAL Lender's Norm 506 - GAS TEST �ndehAddreus 1 certify that I have read this application and euro that the above information is 507 - FINAL PLUMBING artacL I agree to comply with all city and county Ordinances and sum lows relating m buildi^gconstruction,and hereby authorize representatives orthischyusmoo upon the FINA MECHAN CAL above-mendoned property for inspection purposes. O 9 FIN N (We) sprees, cove, indemnify cod Imphick harmless the City of CupenNo against may In my way name against Said City expensof Ilaconsequnce Cj G of the gratsing In consequence ofthisumit. RIND WILL COMPLY WITH ALL NON -POINT Issued by51 WORKS Date SOURC REGULA f� 3prj Re -roofs Type of Roof i um licca^ nuacror am HAZARDOUS MATERIALS DISCLOSURE WIII the applicant m forum Wilding occupant or handle hazardous material c. de0rc0 by ted Cupertino Municiryl Cade. QlaPmr 9.12, and tins Health and Saftty s �flu M3:4)7 / ',DNo All roofs shall be inspected nor to an roofing material being Installed. P P• Y 8 8 Dy. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or futon, building occupant me equipment or deviaa which cult haaardous air contaminants tined by Nc Bay Area Air Quality Management all new materials for inspection. District? DYes Nu Its ave mad the haurdnus mamndstcquiremenu under Chap er 6.95 of the Ctlifor- M.11calN& Safety Code, Sactiom7S505.S533 end 83J4.I unhnuntl thuif Inc Wilding dma bol curamly ha mount that II is my mepauinilny in notify, tie oc up ons or the mquiremcnes which Iha met dor ho issuance or a cenl0cew cupmmy. Signature of Applicant Date l G'xa All roof coverings to be Class "B" or better er or outhofied agent Dom CITY OF CUPERTINO BUILDING DIVISION PERAUUjv OWNER'S NAMH WANG LF ARCHITECTfENGINEER: v o LICENSED CONTRACIUR'S DECLARATION os 1 hereby affirm that i am licensed under provisions orChapter9 (commencing za with Section 7000) of Division3ofdmBusinessandProfusionsCode.andmyifccnseis "] in full force and effect. ti License Class Lie.4 z ^ Date Contractor F ARCHITECTS DECLARATION yy7 tJ 1 understand my pians shall be used at public records a Licensed Professional OWNER -BUILDER DECLARATION hereby affirm that 1 am exempt from dm Cnntraclor's Licenso Law for rhe o O fallowing reason. (Section 70313, Businea4 and Professions Code: Any city or county k m which requires a permit to construct, 111tr. Improve, demolish. or repair any structure r" prior to its issuance. also urns theapplicant for such citta Clea Signed statement gh d that he islicensed purser tan to the provisions orthccontr=mr s License Law (Chapter 9 d F G (commencing with Section7000) DI'Division 3 of the Business and Professions Cade) or iL that he is utmpt therefrom and the basis for the alleged exemption. Any violaliuo or Section 703 L5 by any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars (5500). ❑ 1, as owner of the property, or my employees with wages as their sole compensation. will do'thc work, sad the structure is ilDi intended or ofhted Tarsale (See, 7044, Business and Professions Code: The Comractoes License Law dors not apply m an owner of propeny who builds or improves thereon, and who doessucb work himself or through his own employecs, provided dua such im pmvements ate not intended or offered far sale. !(, however. the building or improvement Is sold within one year orcompleGan, the owner. builder will have the burden of -proving that he did not build or improve far purpose or g), as censer of the propcny, am eid"vely contracting with licensed rnntmaors to construct the project (Sec. 7044, Businw and Professions Code) The Contractods U. cense rs Law donot apply Loan owner or Property who builds or improves thereon, and who contracts [or Mich projectswith aeonuuctor(s)li enscdpursuanttotheContractor's License Law, ❑ I ren exempt U50 Sec, B & P Cjj for this reason J r Dale——t6-2--4n, WORKER'S COMPEI' SATION D ON I hereby alarm under penally of perjury one o the following declarations: ❑ Ihaveandwillmaintain aCeniacrteofconsenttoscirinsucforworkdscompen- } satlon, as provided for by Section 3701 of the Labor Code, for the perfarmance of the work for which this permit is issued. ❑ I have and will maintain Workers Compensation Insurance, as required by Section 3700 of the Labor Cede, for the performance of the work for which this permit is issued. My Warker's CompensaLion Insurance carrier and Policy number are: Cartier. Policy No.: CER77RCATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This scedon need not bo completed If the permit is Cor one hundred dollars (SI 00) or lett) I certify that 1Olin tmante of rhe work for which this permit is issued, f shall not employ anypemanncrso tfgM'eo ^'� U— NO) cal N ETD AP - C, after maid is Csnificate of F.arnyption, yo ou1J become subject to the Worker's Compensation provisions of the LaborCode,.you must O Q farthwitr comply with such provisions or this permit shaft he deemed revoked, z ~ CONSTRUCTION LENDING AGENCY [� 93+ I hereby affirm that there is a eanstruetnn lending agency for the performance of Gr+ , the work for which this permit is Issued (Sec. 3097, Civ. C.) ALrddces Name az LecdersAddress U O 1 certify that 1 have read this application and state that the above information is ir+ correct_ I agree to comply with all city and county ordinances and stilt laws relating to 0 U building construction, and hereby autnarirerepresentatives ofthiscitytocntcsuponthe a above-mendonedpmperW for laspectonparpms. (We) agree to save, indemnify and keep harmless the City of Cupertino against F"c till liabilitIcsJudgments, costsand expenses which may in any way 2cme against said City U F4in consequence of the granting or this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT PER"'03030025 '9�gn6/2003 b"ANITARY NG, • HLDG Job Description ADD 693 SQ.FT./REMODEL Sq, Ft. Floor Area CONTROL NO. BUILDING PERMIT INFO ELECT PLUMB MECH $ 3 0 011�pttion Type JL U'l. - r v` INlj fie' Vad Inspections 102 - PIERS 103 - UFER 104 REBAR 105 - ANCHOR BOLTS 106 - SEWER & WATER 202 - UNDERFLOOR PLUMBING 203 - UNDERFLOOR MECHANICAL 204 - UNDERFLOOR FRAME 205 - UNDERFLOOR INSULATION 301 - ROUGH PLUMBING .302 - TUB & OR SHOWER 303 - ROUGH MECHANICAL 304 - ROUGH ELECTRICAL 305 - FRAME 306 - HOLDOWNS 307 - INSULATION 308 - SHEETROCK 309 - EXTERIOR LATH 310 - INTERIOR LATH 311 - SCRATCH COAT 313 - ROOF NAIL ' 501 - FINAL ELECTRICAL ENERGY 502 -- FINAL PLUMBING ENERGY 503 - FINAL MECHANICAL ENERGY 504 - FINAL BUILDING ENERGY 505 - FINAL ELECTRICAL 506 - GAS TEST 507 - FINAL PLUMBING FINAL MECHAN CAL %509 FZN a. GRAD G Issued by WORKS Date Re -roofs YJLoLo plicanV nlraclormo HAZARDOUS MATERIALS DISCLosIJRE Type of Roof Will the applicant or future building am itanl smm or handle hazardous material as defined by the Cupertino Municipal Code, Chapicr 9.12, sad the Hcahh and Safety Code, Section 25532(a)7 IU No All roofs shall be inspected prior to any roofing material being installed. Will LIm applicam of future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove emit hazardous air contaminants efnned by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes Nu I have read the hazardous materials requirements under Chapter 6,95 of the Califor- nia Health &SafctyCode. Sections 25505,25533and25534.Iunderstand that ifthe building docs not currently haFpp tenant. that it is my responsibility ro notify the occupant of the requirements which_tbtttt be met.odor to Issuance of a Ccrriacamafi0rcumaney. Dam Signature of Applicant Date All roof coverings to be Class r'B" or better ilmlla �.�TY OF CUPERTINO �) -3 `2ITY OF PERMIT APPLICATION FORM CUPERJINO Quantity Fee ID Fee Description Fee Group BAp13LOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits .foot BUILDING BBOILER1 Boiler <= 100,000 Btu MECHANICAL BB00XLER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOZLER� Boilerr> 1M to 1.75 M Btu MECHANICAL BBOTLER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comrn/Quasi BUILDING BCONST�B Con. Tax for B Zone BUILDING BCONSTA Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <=1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING g1ESTIGA Investigation fee BUILDING BM TIGATC Comm. Housing Mit. Fee BUILDING 1 of CITY OF CUPEkTINO t,i TY OF CUPERTINO PERMIT APPLICATION FORM uanti Fee ED Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNBWMULTI New Multi -Family Res MECHANICAL BMNEW SF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL 13NUCOMUT New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTIME .Ins ection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFIJE ]Bldg Permit Fees BUILDING BPFIXTURE Pbig Fixture PLUMBING BPGAS Gas Pi2ing System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Baclflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Tra' PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER InstalUAlter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfrn MECHANICAL BREMAIRHAN AIC Units <— 10,000 cfm MECHANICAL BREMAPPLI AppEance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Li gpg Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREWMAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2 of 3 aCITY0 MYOF CUPERTINO cuINo PERMIT APPLICATION FORM uanti Fee ID Fee Descri tion Fee Group BREMPO R Power Device/A aratus ELECTRICAL BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL R-EM REPALT Repair/Alter Heating_MECHANICAL g MRESApp Remodel Res Appliance, ELECTRICAL BREMSIGNAD Rmdl Si Add Branch ELECTRICAL BRgMSIGNS Remodel Sips, Mar uee ELECTRICAL BREMTHEATR Theatrical Li tin Fix ELECTRICAL CAL Vent Fan Single Duct MECHANICAL BgEMVE 4§ - Ventilation Systems MECHANICAL BSCBLVD Scb Specific PIan BUILDING BSEISMICQM Seismic Commercial BUILDING BSEISWgCRE Seismic Fee Res BUILDING BSPECIAL Special ection BUII�DING BS Swimmin Pool BUILDING BTENP Tqmporyy Power ELECTRICAL BTEN VE Tem or Bldg Permit BUILDING BTEMp$VCS Tem Dist Svcs ELECTRICAL BVSLIC Business License BUILDING ELECTRXC Electricals foot ELECTRICAL EPERNIITE Elec Permit Issuance ELECTRICAL MPERIV¢EE Mechanicals . foot MECHANICAL NII,ERMITFEE Mech Permit Issuance MECHANICAL PpERMITFEE PlumbingMB Permit Issuance PLUING Fee pPLBG Plumbin s' foot PLUMBING ZIDCHG Address Chane BUILDING 3 of 3 ,o0 iCR z .a LU L) O Q�Q 2oaaa LmLi D^vr -rcC}Zr� DC z :) R CITY OF CUPERTINOh� r� k 3 f BUILDING DIVISION PERT�—•-• �y �1� CO4:slTJl�Y-3LCTOWIINFORM ©N BUILDING ADDRESS; CCK CONSTRUCTION INC PERMITNO03100179 65 CANDLELIGHT OWNER'S NAME: 12204 PLUMAS DR PERMIT ISSUE DATE WANG LEVER AND NINA TRUSTEE 10/24/2003 PHONE (4 0 8) 863 - 064 8 SANITARY NO. CONTROL NO. ARCHITPMENGINEER; BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o a 0 0 LICENSED CONTRACTOR'S DECLARATION ' Job Description I hereby affirm that I am licensed tinder provisions of Ctaptes 9 (commencing with Section 7000) or Division 3 of the Business and Professiurs Code. and my license is infulIforce and efrcct. REVISION --IN HOUSE USE ONLY Litcnw ClassLie.7 Date cnntrattar NO NEW PERMIT ISSUED/ORIG. #03030025/03080173 ARCHITECT'S DECLARATION 1 understand my plans shall he used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractors License Law for tho follnwing reason. (Section 7031.5. Business and Professions Code: Any city or county which regcires a permit to construct. alter. impmve, demolLah, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions mf the Caatraclar's license Law (Chapter 9 Sq. Ft. Floor Area Valuada O 10 7 . (commencing with Section 7000) of Division 3 of the Business and Professions Code) ur that he is exempt urcrefmm and the basis for the allcgcd exemption. Any vlolatlon of 3 @ i'ber0 0 Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Dat more than live hundred dollars ($500). - ❑ I, as owner of the propeny, or my employees with wages as their sole compensation, Required Inspections will do the work, and the mclure is notintended oroffertd forsale.(Sec. 764.7, Business and Professions Code: The Contractor's License Law does not apply to an owner of Q P pmpeny who builds or improves thereon, and who does such work himself or through his own cmpinyccs, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owncr. builder will have the burden cC proving that he did not build or improve for purpose of sale.). ❑ 1, as owner of the prnpcny, am exclusively contracting with licensed contractors to eonstrucs the project (Sec. 7044, Business and Professions Code;)The Contractors Li- , cense Law does riot apply to an owner of property who builds or improve thereon, and who contracts forsuchprojects with Acentracmr(s)licenscdpursuxrltothe Conuacrors , License Law. ❑ I am exempt under Secy , B & P C for thinreason Date �6 !�, - 0 ORKER'S COMPENSATION DEC L.A!`T [hereby affirr7 under penalty of perjury one or the f I ng declarations*. I have and will maintain a Ceniriicam cfConscnt to sell -insure for Werkcr'sCompen- sation, as provided for by Section 3700 of the Labor Cade, for the performance of the ' work for which this permit is issucd. ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Codc, rot the performance of the work for which this permit is issued. My Workers Compensation Wiinince carrier and Policy number arc; Carrier'. Policy No,: CERTIFICATE OF E7(EMPTION FROM WORKERS' COMPENSATION INSURANCE (This seclien need notbeeomplered If the permit Is forone hundred dnllars (SI00) nr less.) 1 certify that in Fhe pedormacca of the work for which this permit is issued, 1 shall not employ anyper3 ni , m�r�Ut be an}csu jcettathcWerkers'Compcnsatlon - Laws of Califor ata CLCD Applican NOTICE AP L1 NIT: Ir, dier making this Certificate of Exemption, you should brcCOmWftfijcCL to the Workces Compensation provisions of the Libor Code, you must forthwith comply with such provisinns or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that them is a eonstruclinn lending agenry for the pedurmance or the work Cnr which this permit Is issued (Sec. 3097, Civ, C,) Lzndmes Name Lenders Address 1 tutify that 1 have read this application and state that the above informafrun is ' correct 1 agree to comply with all city and county ordinances and sum laws relating to building construction, and hereby au ihorize representatives orchis city to cntcrupon the above-mentioned property for inspection purposes. o�5 (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilides,judgments, costs and cKpcnsos which may in any way accrue against said City in consequence of the granting of this permit. ' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date RCEREGUL.ATIO S. ­O/i l Re -roofs Type of Roof �+ '511940g. afApplican Contractor Da HAZARDOUS MATERIALS DISCLOSUR Will the applicant or future building uceupmLslore or handle hamrdous material as defined by the Cupersino Municipal_ Code. Chapter 9,12, and the Health and Safely Code,SccYes 25532(x)7 ❑ Ya Ir31 y�No All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which cmlt harardous air contaminants as dcrrncd by the Bay Arca Air Quality Management all new materials for inspection. Disuitt? • *1P ❑Yes I have read the hazardmus materials requirement& undcrChapter 6.95 of the Cali ror- nlaHealth& Safety Code. Secdons25505,25533and 25534.lundcrsmndthalirLbe building does not currently have a levant, that it is my responsibility m notify the occupant or the requirements which m4t be mel prior to issuance ora Cartirx:am of cupanajr� y (G/are [Signature of Applicant Date j- All roof coverings to be Class "B" or better own raut(iori.,ca gent CITY OF CUPEkTINO %.:ITY OF CUPERTINO! `f PERMIT APPLICATION FORM b 3 _A Quantity Fee ID -2-4 o q7 Fee Group BAPPLOTHER Building Addreo i-� 6,11-& ` I-jatl Owner's Name r �f j one # >_ n� 3 — c� Contract C- C_ Cc. Cv►� s � icense #: 6PI a ( o Contact t� MECHANICAL Cupertino Business License#: B ng Pe •t Info. BIdg lett ❑ Plumb ❑ Mech ❑ Job cription: sidential ❑ MECHANICAL Commercial ❑ Sq.Ft. Floor Area: MECHANICAL BCONSTAX $/Sq.Ft.: Cost of Project: BCONSTAX Ind/Off/Comm/Quasi Occupancy Gr(%L"-- Type of Construction: ` BUILDING Nq Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE -Bldg Permits . foot BUILDING BBOILERI Boiler < = 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING �Z3S� 1 of 3 CITY OF CUPE}�TiNO _JTY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-FamilyRes MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm EIectric ELECTRICAL BNUCON f M New Comm MechanicaI MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTM E Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Repi e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn Sprinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BRENLURHAN A/C Units <=10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BRENIINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL • 2 of 3 CITY OF CUPEkT[NO ,ITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Apphance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMT.UBATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan, BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECL ,L Special Inspection BUILDING BSW-W Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Tem orary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERAHTFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Change BUILDING 3 of 3 f