1648 eF:"•iRiO ��
CITY OF CUPERTTIINO cccc °r `�'
APPLICATION FOR COMMERCIAL BUILDING PERMIT D G A- PERMIT NUMBER
AND
\1 CERTIFICATE OF OCCUPANCY FOR APPLICANT TO FILL IN
• DI P 91 f 'RfR ET ADDRESS OF PROJECT: Susi F
r • O `� .5,..�C /�rV-2,5, .�L.✓ .........................
..,�.. ...7... .Q. _. . -
Plans Received By...................................................Date , Legal Description: Tract................. Block..... Lot......................
REO.: Plans.... Survey.... Calcs: Struc..... Energy.... Elect._.. Mach.... Description of Work: ...110' .:�L.A...,/L�',?/"L�.Q.v�h: ..
Plans Checked By........................... Date .. ... ... 1st Struct. Improvement on Parcel: Yes.... No.... Area of Bldg...............
Application Approved By. ....,.......Date .� . ..3 .. (J 0 Separate Structure............ or Addition/Alteration to Exist. Bldg...........
Validated B ..... .......................
By...............................................................Date ...... ............. No. of Stories....._......... Useof Building ............. ..
Compensation Certificate Verified By Date .......... Valuation of Pr!! o : $...... ./.0-0.Q................... _..........................
• • • . $ 4 111 � Owner: ...SIC -... Ph ne'�,5,_.6 0
2 Co tracto _ city Bus, L c. . ............ ...
Permit Fee (plus penalty if applicable) ...._......... ._...$...Jqq^ _..:rrO Address: ._U_ .o.:G..S-,5�.8......vrn�:..._...___. Phoneaj�.7. ... ...
Plan Check Fee (less deposit of $.......... Rct. #.....__.)$..raC.(`Q/rJ.._..
Energy Plan Check Fee (Dep. of $..... Rct. #........)$.......__..... Contractor - Electrical: .............................
Strong Motion Fee ........._.._...._.................................._.$.......... SO City Business License)*.-}..... Phonew7-..Y(.3 xf
Plumbin /-�..�+tffF�*-C.:......... .....................
PlumbingPermit Fee $... ..7a( 9: ............ ... . ........ ....... r
.............................................. . r City Business License *. ....... .. PhoneglY..^.�/.!:r
Electrical Permit Fee .._._..._............._...........................$..a,.C�/ Heating and Cooling ..........�y5L, A............... .. . ........ -�
Mach. Htg./Coolg. Permit $ ..............................$...�3.C1T0..... City Business License *.................... Phone�r-7_;j.27
Construction Tax.............................................$.... .............. ... Architect/Designer: ............................_____...._... Phone:....................
Sewer Conn. Fee .............. Water Conn, Fee ..............$....................... Engineer: Phone:.................
g' ................................................
Landscape Fee .................... Street Tree Fee ............$....................... Lender: f� Unknown
Misc. Fee ..............._....___...........................................$. .. _............. "I certify that in the performance of the work for which this perm 11 la
• YTAM ; $/0,3, &�b Issued I shall not employ anyper on In any manner so as to become subject
to the want ompensetlon I sof California."
Type Const......... Group........ Div........ Occ. Load........ No. Exits........ SIGNATURE OF '
Floor Loads: 1st.... 2nd.... Other.... Sprinklered.... Area Sep. Walls.... APPLICANT/OWNER . r✓ .... .. .._..._. .zewfl. DATE
• • ............ c
ertify the s the applicant I am licensed under the provlelc}�a of the
Contractorsr ic.nse 4y and further that my License No. .,j./..GG..Z/..
Environmental Status: Exempt ....._._.. Other.............. _._...............
in Classification .......,(7.��.................. is in full force and effect: or
Design RBVIBW Approval: Bldg. "'"" """""' """"""Site Sign ............ I certify that I am exempt from the "Licensed Req.'•ed" provislona of the i
Contractors License Law. (State basis of exemption.,
Use Zone ............ P.D. GGOddIGns ......................................._.._....._........ 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 Laws regulating
-Approved By.............___ ...................................... Date ........................... building.
I (We) agree to save, indemnify and keep harmless the City of Cupertino
• ' • against liabitities, judgments, costs and expenses which may in any way
1 occurs against said CI consequ an of t e granting of this permit.
_
croachment Permit.... Grant of Easement.. ._................. t
SIGNATURE OF l
_„urb, Gutter, Sidewalk, Driveway: Replace Repair APPLICANT/CONTRA0TO nh.. ..... .........5'ti'DATE In�i...c. ....SC
Sewer............ Conn. Fee $................ Water................ Meter $................ NOTE: When properly tv ated this form constitutes a Building Pernik. This
Agreement for Completion of Public Works Improvements .................. permit expires and becomes null and void should work not be wmmenced within
Plans Checked By........ Date........ Approved By........ Date.................... 120 day, from validation date, or should authorized construction be •uspandsd or
abandoned for a period of 120 day,altar work Is commenced.
PERMI INSTALLATIOjJ NO, EACH FEE APPLICATION FOR PLUMBING PERMIT
Light Outl ts..�..... Switches...-�....... 12 q , / PERMIT INSTALLATION NO. EACH FEE
with up
o 5
Fi 4.00-
TOTAL NU�BER(less tha1000 watts) .., !7 /....... $ .50 - �' L� Gas Each additional outlet flet. .. $ 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. ,.O.SJ
SERVICE OR TEMPORARY POWER to ................. 2.00 ..._....__.. Lavatory-J, ......... 3.00. tv.
Shower Pan.... Bathtub.... Sink......... /.......
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 ..........................__.............. . ............ 4,50 ...'./.
20/$8.50, 50/$10.00, 100/$12.00, Slop Sink.._._. Floor Sink........ Floor Drain /. _.......... 4.00. .y' .0
500/$15.00 ............................................... .............. ............ ................ Urinal.... Interceptor.... Water Softener.... ...................... 4.00 .............
Signs with I XFMR ...... ... 2.00 .. .............. Plumbing Piping without fixtures ......................�............ 4.00 .............
Each additional XFMR/Time Clock .................... .50 .. .............. Misc. ..............................................................................................
Annual Electrical Maintenance
. ................25.00 .. .............. Permit Fee ..........................................................................$ 6.00
Other (see Ordinance Current) .................. ............................................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. 0) $/
........... . . . • • . • s
HEATIN
LING PERMIT
AT
......................................................................... ............. ...............................
Permit Fee ........................................................................ $ 6,00 PERMIT INSTALLATION NO. EACH FEE
TOTAL ELECTRICAL PERMIT FEE(plus penalty if app.❑) $.w, s V Forced Air Unit_............to 100M ........................ ......... $ 6.00 ��--
• • • . over 100M .............._.._ ........ 10.00 ...............
Comfort Cooling Unit.....to 3 ton/HP ................. ........... 6.00 ...............
Forms / Foundation....,.....t� By:.................. Date:................ to 15 ton/HP........................... 9.50 ...............
--Olumbin9 "a+ - + +".�."...."�.��.��......_../. t-.._.......1d.-3.�e.'Q... to 30 ton/HP..........................12.00 ...............
1gh Electrical ........._.............U.......... . ..................... d} to 50 ton/HP.......................... 17.00 ...............
ane --PTUMUMU-arfd'i'ieeting ........_. ... . ..............t.-...7 ..... Space Heater........ Wall Heater .......................... ...--------6.0o ....._........
:ilation / Energy............................... .................................................... Flues - other than above ................................................3.00 ...
_,es Test ................................................................................................... Vent Fan: Kitchen........ Bath ......�..............................---3.00 .O....:
Temporary Power Qas /f-lett ............. ......................`........ Commercial Range Hoot 6.00 .,,_.....-
Final - Electrical .. . .. .r ,.. ....D...................�....�.. .�/ Misc. ............... ,}C-7,.... CLv .. .........'c
6 q-....::: ........... ...........................s�
Final - Building /Mechanical ................................................................. Permit Fee .......................................................................$ 6.00
Final - Design Review / Landscaping .................................................... TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. Q) �13 D a
Final - Public Works.......... ................................................ .�
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