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2000 CITY OF CUPERT 1. 0 � APPLICATION FOR COMMERCIAL BUILDING PERMIT PERMIT NUMBER a OHO AND CERTIFICATE O OCCUPANCY • ' APPLICANT TO FILL IN BUILDING INSPEGTI V N DIVISION STREET ADDRESS OF PROJECT: r Plans Received By—.................................................Date ......................... Legal Description: Tract ............ Block............ Lot....................". REQ.: Plans.... Survey.... Cafes: Struc..... Energy.... Elect..... Mech._. Description of Work: ..-R 4.!!Q.�FAwi,,...........—...._...................... Plans Checked By................... Date ....p.. p� 1st Struct, Improvement on Parcel:Yes.... No.... Area of Bldg............... Application Approved By..... . Date Separate Structure............ or Addition/Alteration to Exist. Bldg........... Validated By......._—.............. ........................Date ............. ......... No. of Stories............ ... Use pf Building .........._.............................. ........ Compensation Certificate Verified By...... ............ Date ..................... Valuation of Pro'ect: $ c(..Q.O..............................._............. .".".... s , s .. • $ / DO Owner: ....Jr. ..d/Q'................................................ Phone:.................... r q Q Contractor: .,O.G.1Q .e......... City Bt/f.Lic. a............. Permit Fee (plus penalty if appl}'�able) ............ ...........$.f¢5.1........._- K C Plan Check Fee (less deposit o4ll.... Rct. #.........)$....1. . '� Address: ...a, .�.JS ! --D44..S...._..,...._.... Phone:.31,.V.lx.y """"" Contractor - Electrical: ............................. Energy Plan Check Fee (Dep. of .Op. Rct. #........) $...._....._ City Business License #.................... Phone:.................... StronStrom Motion Fee ................. ..........1. C ............$.......f.."5�...v g (//p ' Plumbing: ................_..........._......._.............--............................. Plumbing Permit Fee .........n ,�C,A, $-- ryp ^ry�• City Business License #.................... Phone:.................... 'r ...7............ �. Electrical Permit Fee .....".__......".....,(..&-.........._lye...$.................... _ Heating and Cooling .._......................_.......................—......._.. Mach. Htg./Coolg. Permit $ .. .............0I $....-.... City Business License #........... ....... Phone:.................... Construction Tax.. .........$....................... Architect/Designer: Phone:.................... SewerConn. Fee ............". Wats Fee ..............$....................... Engineer: .................................................................... Phone:................. Landscape Fee .................... Street a Fee ............$ ... .. Lender: ................................................................................"...�.................. Unknown Misc. Fee ......................... _..._..._..._..............$__. ^I certify that in the performance of the work for which this permit is • , ; $o`v �� issued 1 shall ngemy any per on in any manner so as to become subject totheworkmannsay 1 Celilornia" Type Const......... Group........ Div.... .. Occ. Load........ No. Exits......., sloNAruRE oP // q 9yFloor Loads: 1st... 2nd.... Other.... Sprinklered... Area Sep. Walls.._ APPLICANT/OWNER .......... .................DATE �vmo . • - • _ ............ I certify t t as the applicant I am licensed under the pro isions of the Contracto icense Law and further that my License No. ..........................." Environmental Status: Exempt ...c.._... Other.._................... in Classihcatlon ................--...................:is in full farce and effect: or ; .Sign ......._... Design Review Approval: Bldg. Site Sign certify that en exempt from the is of exemption.,Rtion., tl" provisions oft e --���— """""" """""' - Contractors License Law. (State basis al exemption., Use Zone P.D. Conditions ......... ......__. ............................._.................... I hereby acknowledge that I have read this application and state that the above Is Cond, Use Permit e...... Variance e...... 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 liabilities, jutlg mart s, co is and expe ser which mays any way acture against saitl City in c uo e e grantin of this troll 9 Encroachment Permit........._............. Grant of Easement.........._............ SIGNATURE OF Curb, Gutter, Sidewalk„ Driveway: Replace Repair APPLICANT/CONTRACTOR ........... .-....................... DATE �[..!!`�.� Sewer............ Conn. Fee $................ Water................ Meter $................ NOTE: when properly a ated this form constitute* a Building Permit. This Agreement for Completion of Public Works Improvements .................. permit expires end be as null and void should work not be wmmenc•d within Plans Checked By........ Dale........ Approved By........ Date.................... 120 days from velidall n date, or should authorized conaWelbn M suspended or abandoned for a period of 120 days Baer work Is commenced. APPLICATION FOR PLUMBING PERMIT • •• PERMIT INSTALLATION NO. EACH FEE Light Outlets._........ Switches............ PERMIT INSTALLATION IIINO. EACH FEE Fixtures............ Receptacles............ Gas Sytem with up to 5 outlets ....................."..."......... $4,00 TOTALNUMBER(lessthan 1000watts)_.. ........._..... $ .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/$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/$6.50, 50/$10.00, 100/$12.00, Slop Sink........ Floor Sink.....— Floor Drain 4.00 ------""""."" .. ... 4.00 500/$15.00 ............................................... .............. ................ ............... Urinal.... Interceptor.... Water Softener.... ........."............ ............. Signs with I XFMR .......................--........... ............ ._ 2.00 - Plumbing Piping without fixtures .._................." I....._.... 4.00 ..........".. Eachadditional XFMR/Time Clock .. ........_...... .50 .. ..._......... Misc. .............._.............—......................_............................ ........—..""...... Annual Electrical Maintenance . ................25.00 ................ Permit Fee ..........................................................................$ 6.00 Other (see Ordinance Current) .....—.......... .............. .-............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. p) $ ....................._....._..................................._..... _..........._......._.................... APPLICATION • • HEATING/COOLING .. ... ..... Permit Fee ........—.......__................................................ $ 6.00 PERMIT INSTALLATION NO. EACH FEE TOTAL ELECTRICAL PERMIT FEE(plus penalty if app.❑) $ Forced Air Unit...............to 100M ........................ ...—... g 6.00 ............... INSPECTION RECORD over 100M ............................ 10.00 ...""""........ Comfort Cooling Unit.....to 3 ton/HP............................ 6.00 ............... Forms / Foundation............................... By:.-............... Date:................ to 15 ton/HP......................... .. 9.50 .............". Plumbing Ground Work ............................ .. to 30 ton/HP..........................12.00 ............... ...... ............ " 17.00 ought Electrical ....................................... .................... .� f to 50 ton/ .................... .... ."." .. ame - Plumbing and Heating .............................................................. Space Heater........ Wall Heater .......................... .........".6.00 ............... nsulation / Energy"...."".........."................................................................. Flues - other than above .................. .............................3.00 ............... GasTest .................................................................................................... Vent Fan: Kitchen........ Bath —......... ............3.00 ..........."".. Temporary Power Gas / Elect......"............"..........."..........."".................. Commercial Range Hood .............. 8,00 ,,....,,,,,,,_, .................... ........... Final - Electrical .....................—............. ............._.................................... - Misc. ............—.....................—............"....""........""....................................... Final - Building/ Mechanical "................................................................. Permit Fee .................................."".................................... $ 6.00 Final - Design Review / Landscaping ......................... ........................... TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. O) $ Final — Public Warks...........................................................