1567 03-9737 • � �%l
CITY OF NIN]. INO
PPLICAI FOR COMMERCIAL BUILDING PERMI PERMIT NUMBER {�
OND
CENIFIC-ATE NU OCCUPANCY • ' CANO FILL IN
6\ 1 BUILDING INSPECTION iti
/ STREET ADDRESS OF PROJECT:
r
18.4 2 2...F.or.ge...Drive.._._............_.................. ..................
Plans Received By............................._......._...........Date ................... Legal Description: Tract..._.................. Block..........._ Lot............_........ -
REQ.: Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach..... Description of Work: ........__......._.........................................................
Plans Checked By........................... sees... Date ....... .. 1st Struct. Improvement on Parcel:Yes..-. No.... Area of Bldg...............
Application Approved By............./4v_�...r..._.�.....Date ..��.. /Qu.. Separate Structure............ or Addition/Alteration to Exist. Bldg......
Validated By.............................................................Date ....sees...... No. of Stories................ Use of Building ___..........................................
..
Compensation Certificate Verified By........ Date ..................sees... Valuationof Project $.....160.0...00.................._....
M
a • • • • • E l FiM Owner: _.. sees. _ ...........emorex............._..........._..... ._.........inee.Ci Lic. •...1710..2_..........Phone2.a./..
. -�-_Q.Q
_
Permit Fee (plus penalty It applicable) ..............._..._.-$....16...00..... Contractor:OrVin...En g
Plan Check Fee less deposit of $.......... Rct. *..........)$sees.. Address: r - Ele...$1lfEZ' S$31't ldrdphone�.32.-21-9
( p 10','40""'-' Contractor - Electrical: �.._sees
Energy Plan Check Fee (Dep. of E........ Rct. #........) $._._......_......._ City Business License *._...._._....... Phone:....._.............
StrongMotion Fee ........................................_........._._$........_...50..... Plumbing: _................sees-......_.-...............................................
Plumbing Permit Fee ._.................._._ta ....._...$.__.._.............. City Business License #....... ............ Phone:....................
Electrical Permit Fee ..._.............. •� .. ................$..._........._..-._. Heating and Cooling
_C`.,sees._ ... _......_..........__......................................_..
Mach. Htg./Coolg. Perm Ltrtl' ..:...........................$........._............ City Business License a r......._........... Phone:....................
Construction Tex.........................i,,
.$ . Architect/Designer: ..._....................._._._sees._......... Phone:....................
Sewer-Conn. Fee ............. W r C(tnn. F`ee ..._......_.$_..._...._....... Engineer: Phone:..................
9
Landscape Fee ................`VLSlie
et Tree F sees . $sees. ..-... ........ Lender: Unknown
sees... �..................
Misc. Fee ......................... ........ "I certify that In the performance of the work for which this permit is
s 32.90 Issued I shell not employ any person in any manner so an to become subject
to the workman's compensation laws o(Celiforns."
Type Const..__._ Group........ Div..__... Occ. Load........ No. Exits....._ SIGNATURE OF
Floor Loads: 1st.... 2nd.... Other.... Sprinklered.... Area Sep. Wells.... APPLICANT/OWNER ...................................................................DATE ..........._...............
ZONING - •UIREMENTS ............ I certify that as the applicant I am licensed under the provisions of the
Contractors License Law and further that my License No. ._............_...........
In Classification _.......... Is in full force end effect: or
Design
Environmental Status: Exempt......._... Other ............ Sign
.......__' I certify that I am exempt from the "Licensed Reg.'•ed" provisions of the
Design Review Approval: Bldg. ............ Site ...._....... Sign ............
Contractors License Law. relate beats exemption.,of
Use Zone ............ P.D. Conditions ......... ....................... I hereby acknowledge that I have read this application
llon a end arms that the above is
Cone. Use Permit M....-. Variance +r...... Parking Spaces_.. Load. Sp..... correct and agree to comply with an City Ordinances and Siete Laws regulating
Approved B .........._................ Date ._........... _
.. ...sees., building.
APp y I (we) agree to save, Indemnify andqharmtee City of Cupertino
against liabilities, judgments, costhich may In any way
acture against said Ci onseqting of this permit.
rmit........................ Grant of Easement......._..-.'_...._..... SIGNATURE OFCurb, Gutter, Sidewalk„ Driveway: Replace Repair APPLICANT NTRACT _ ATE ....._..._..........Sewer._._._... Conn. Fee $_sees....._... Water................ Meter $. ..._._.... NOTE: •n p r Ildelad thise Building PemYl. This
Agreement for Completion of Public Works Improvements .............sees. P•rmit a IM a a null end ot be commenced Wstln
Plans Checked By........ Date........ Approved By........ Date........_......... 120 day WdMlon dm, or Mould authorised conwuceon be suspended a
APPLICATI• abandonedabroned for a Period of 120 days after work is commenced.
N FOR ELECTRICAL PERMIT
APPLICATI
PLUMBING PERMIT
PERMIT INSTALLATION NO. EACH FEE • • •
Ligh' Outlets............ Switches............ PERMIT INSTALLATION NO. EACH FEE
Fixtures............ Receptacles.._._._.. Gas Sytem with up to 5 outlets ............_._..................$ 4.00 ....-.... .
TOTAL NUMBER(loss than 1000 watts) ... ._sees._... ... $ .50 .... ...... 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 .............. Lavatory.... Shower Pan.... Bathtub.... Sink................_ 3.00 „..........
100 amp/$6.00, 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.:._.., _sees.. ..... .............
per HP—KW—KVA to 1/$2.00. 5/$3.60. Vacuum Breakers ........................_......._.... ._. ............. 4.50 ......_.....
20/$6.50, 50/$10.00, 100/$12.00, Slop Sink........ Floor Sink........ Floor Drain .... ......... ... 4.00 .............
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 ...................................._....................................E 6.00
Other (see Ordinance Current) ................. ........._... ....._....... .............. TOTAL PLUMBING PERMIT FEE (plus penalty if app. [3) $
1..... ...._.- • •.
HEATING/COOLING PERMIT
..
........ ..................................._....._.............__............_ ..._........._ ....._.........
Permit Fee ......._............................................................. $ 6.00 PERMIT INSTALLATION NO. EACH FEE
TOTAL ELECTRICAL PERMIT FEE(plus penalty if app.p) $ Forced Air Unit...._.........to 1DOM ....................... ......... $ 6.00 ...............
• - . over 100M .................... ._.... 10.00 ..............
Comfort Cooling Unit.....to 3 ton/HP...................._._.... 6.00
Forms / Foundation_.._...._........._........ By:__............ Date:................ to l5 ton/HP......._....... .....-..-. 9.50 ...............
umbmg Ground Work ............................. ....._..._................................ to 30 ton/HP......................... . 12.00 ...............
ugh Electrical.........._...............__....... ....._............................................ to 50 ton/HP................ ........ 17.00 ..-............
me - Plumbing and Heating .........................................................._.. Space Heater........ Well Heater ............._._._.... ............6.00 ...........----
ulation /Energy............................... ................................................... Flues - other than above ................................................3.00
........-sees..
ea Test ............................................................................................... ....... ........... ...... ...Commercial Range Hood .._........... ,. 6.00 _.............
.............................. .
Final - Electrical ........................................................................................ Misc.
....................................................................................
Final - Building/ Mechanical ._.................... ..._...._.............................. Permit Fee ............................................._......_................. $ 13.00
Final - Design Review / Landscaping ................. .............................. TOTAL Htg./ Coolg. Permit Fee (plus penalty It app. p) $
Final — Public Works...........................................................