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CITY OF. CUPERTINO • CITY OF�UPE M11 t 1 1981 APPLICATION E CAL BUILDING PERMIT PERMIT NUMBER 2,© 3 AND P CERTIFICATE N r FOR APPLICANT TO FILL IN BUILDING INSPECTION DIVISION STREET ADDRESS OF PROJECT: DEPARTMENT t....PS4.��...................._._........._.................... Plans Received By.................................................Date ... ........ Legal Description: Tract...................... Block............ Lot_.........._....... REO.: Plans.... Survey.... s: Struc..... Energy__ Elects�.,,// h .. .Description of Work: .EfC! ..._................._...._............................. Plans Checked By........... ... Date — 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 of Building ....____............................._... ... Compensation Certificate Verified By.................... Date .............._........ Valuation of Protect $..... .,..Od.C7...................................................... . .. . $ -Owner: ....15.;5e a......Pc ................ Phone:SY�.-Fib x93; . .....$ 0:.... Contractor: ._................. ._......_....._ City Bus. Lia ................. # ............... Permit Fee (plus penalty if applicable) .................. a .. Address: ..._....._........__.........._.........................._.... Phone:.................... Plan Check Fee (less deposit of$.......... Pet. #..........)$..1..3............ Contractor - Electrical: .............................................................................. Energy Plan Check Fee (Dep. of $........ Rct. #........)$........_... . City Business License #... ....... ... Phone:.................... StrongMotion Fee ..........................................................$..........<........0 Plumbing: ......................... .................................................... Plumbing Permit Fee ................ $_............._..... City Business License #................... Phone:.................... Electrical Permit Fee ..._.........................................._...$.............__..... Heating and Cooling .................................................................. Mach. Htg./Coolg. Permit $ ..............................$....................... City Business License #.................... Phone:.................... Construction Tax.............................................$._.................... Architect/Designer: ......................................_......._. Phone:.................... Sewer Conn. Fee ....._... ... Water Conn. Fee ....._------$.._..........__..-. Engineer: _............._..... ........................................... Phone:.....Un...k.. Landscape Fee ..... _ _ .. ............... Street Tree Fee .. ........$......._ .......... Lender: ..........__............._...... ............_ .. ............ ..................0.. nown ................ Misc. Fee __........ ....................................._...__...........$........�..._ "I certify that in the performance of the work for which this permit Is • , , , : $ S issued I shall not employ any person in any manner so as to become subject to the workman's compensation laws of California." Type Const......... Group........ Div.... .. Dec. Load........ No. Exits........ SIGNATURE OF Floor Loads: 1st.... 2nd.... Other.... Sprinklered.... Area Sep. Walls.... L APPLICANT/OWNER .J..,J.......... ...... .... ...........DATE yl.)..J&..)........ ZONING ........... certify that as the appl n am Iican ed under the provisions of the Contractors License Law d further that my License No. .................. Environmental Status: Exempt............ Other..................Sign............... in Classification ..........................._........... Is in full force and effect: or Design Review Approval: Bldg. . Site Sign certify that en exempt tram the is censetl Req, ad"d'• provlelone of the ----- """""" """"-""'"" 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 Permi.t #...... Variance #...... Parking Spaces.... Load. Sp..... correct and agree to comply with all City Ordinances and State Laws regulating Approved B _ .................................._.. Date ......... ................ building. Pp y I (we) agree to save, indemnify and keep harmless the City of Cupertino r •' • against liabilities, judgments, costs and expenses which may in any way r acture against said City in consequence of the granting of this permit. Encroachment Permit.-..................... Grant Of Easement........................ SIGNATURE OF Curb, Gutter, Sidewalk,. Driveway: Replace Repair APPLICANT/CONTRACTOR ...................................................... DATE ..................-........ Sewer............ Conn. Fee $................ Water................ Meter $....................... NOTE! When properly validated this form constitutes a Building Pormit. This Agreement for Completion of Public Works Improvements .................. permit expires and becomes null end void should work not be commenced within Plans Checked By........ Date........ Approved By........ Date.................... 120 days from validation date, or should authorized construction be suspended or abandoned for a period of 120 days after work is commenced. APPLICATION FOR PLUMBING PERMIT • • • PERMIT INSTALLATION NO. EACH FEE Light Outlets............ Switches............ PERMIT INSTALLATION IIINO. EACH I FEE Fixtures............ Receptacles............ Gas Sytem with up to 5 outlets ................................... $4.00 TOTALNUMBER(less than 1000 Watts).... ................ $ .50 ------ Each additional outlet ......... ......................I .......... 1.00 ....t........ 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 ....................___............. ............. ..........I ......... . 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.............. 500/$15.00 ............................................... ............. ............ ................ Urinal.... Interceptor.... Water Softener.... ...................... 4.00 ............. Signs with I XFMR ....................................... ................ 2.00 .. .............. Plumbing Piping without fixtures ........I............. ............ 4.00 ............. Eachadditional XFMR/Time Clock .. ................. .50 .. ....._......_ Misc. ....................................................................................._....... ........ Annual Electrical Maintenance . ................ 25.00 ....__........ Permit Fee ........................................................................$ 8.00 other (see Ordinance Current) .................. .............. ................ .............. TOTAL PLUMBING PERMIT FEE (plus penalty if app. [-]) $ ............. ................. .............. . APPLICATION FOR HEATING/COOLING PERMIT ......................................................................... ............. ................ Permit Fee ......__.............................. $ 6.00 PERMIT INSTALLATION NO. EACH FEE TOTAL ELECTRICAL PERMIT FEE(plus penalty if app.❑) $ Forced Air Unit...............to 100M ........................ ......... $ 6.00 ............. INSPECTION RECORD over 1DOM ............................. 10.00 --------------- Comfort Cooling Unit.....to 3 ton/HP................. ........... 6.00 ............... Forms / Foundation............................... BY%_.............. Date:....__.._.... to 15 ton/HP........................... 9.50 ............... ' PlumbingGround Work ......................... ................................................_. to 30 ton/His................ .......... 12.00 ............... -ougIt Electrical ..................................... ................................................... to 50 ton/HP................ .......... 17.00 ............... ams - Plumbing and Heating .............................................................. Space Heater........ Wall Heater ................................... ..1 6.00 ............... nsulation / Energy........................................................ ........................... Flues - other than above ..............__.................. ............3.00 ............... Gas Test .......... Vent Fan: Kitchen........ Bath ...............-.............I...........3.00 .-------------- Temporary Power Gas / Elect............................................................... Commercial Range Hood 6.00 ,.,,,,,.,,.,,,, Final - Electrical ..................................... ................................................... Misc. ................................................................................ ........................... Final - Building/ Mechanical .................................................................. Permit Fee .......................................................................$ 6.00 Final - Design Review / Landscaping ..................... TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. C]) $ Final — Public Works...........................................................