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1939 t � n PERMIT NUMBER FOR APPLICANT TO FILL IN STREET ADDRESS OF PROJECT: . . . 1.0.`1.3..I......RX1.r1E.�l .R......0 1%kT(�►o.........Gt...................... Plans Received By....................................................Date ......................... Legal Description: Tract....................... Block.. ....... Lot...................... REO.: Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach..... Description of Work: '15.6'15.6 1.b.(IT........ U_�...................................... Plans Checked By.................................ee Date .... .... tat Struct. Improvement on Parcel:Yes....No....Area of Bldg............... Application Approved By............ Cr..f.....Date .d/.�.. /jfJ Separate Structure............ or Addition/Alteration to Exist. Bldg........... Validated By..............................................................Date ......................... No. of Stories................ Use of Building .................................................. Compensation Certificate Verified By....................Date ......................... Valuation of Project: $....400.................................................................. Owner: ....... -& ..................._. Phone:.................... Contractor: 1�arCF+T....................... City Bus. Lic.#............. ... Permit Fee (plus penalty if applicable) ........................$...................... e................................................. Phone:... ' Plan Check Fee (( d Rct. #..........)$....................... Contractor Electrical: la M. � --a�O � Contractor - Electrlcal: .............................................................................. Energy Plan Check Fee (D ....... Rct. #........)$....................... City Business License a.................... Phone:.................... Strong Motion Fe ❑❑.................................................. $...................... Plumbing: Plumbing tionPerF e . ...� �p $... ...................................................................................... nZ ....�JC2.,........................... .. City Business License #.................... Phone:.................... Electrical Permit Fee ......................................................$..../....(�"d....... Heating and Cooling ........................ Mach. Ht /Coolg. Per 't $ $....................... ..........#.............................. g• gy t�� City Business License #.................... Phone:.................... Construction Tax.......1CI�LJ,............................$....................... Architect/Designer: Phone:.................... Sewer Conn. Fee .............. Water Conn. Fee ..............$....................... Engineer: Phone:........k.. Landscape Fee .................... Street Tree Fee ............$-..................... Lander: ....................................................................................❑........Unnown Misc. Fee ........................................................................$....................... ............ "I certify that In the performance of the work for which this permit Is e , , , : $ Issued I shall not employ any person In any manner so as to become subject to the workman's compensation la of Callfomla." Type Const......... Group........ Div......... Occ. Load........ No. Exits........ SIGNATURE OF 2, _ Floor Loads: 1st.... 2nd.... Other.... Sprinklered.... Area Sep. Wells.... APPLICANT/OWNER ......... . .. .... ... .... .. .. GATE.._ . ZONING # ........... 1 cenity that m the applicant am Ilcena under the provisions o/ the Contractors License Lew and further that y License No. ................ Environmental Status: Exempt............ Other............... in Classification ........................................ Is In full force and enact: or ................ Design Review Approval: Bldg. Site Sign ............ I certify that I am exempt from the 'Licensed Req.'rod•' provisions o/the """'-"' """""" Contractors License Lew. (State basis of exemption., Use Zone ............ P.D. Conditions ............................................................ I hereby acknowledge that I have read this application and slate 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. Indemnity and keep harmless the City of Cupertino e• s against liabilities, judgments,costs and expenses which may in any way • acture against said City in consequence of the granting of this permit. croachment Permit........................ Grant of Easement........................ SIGNATURE OP Curb, Gutter, Sidewalk,. Driveway: Replace Repair APPLICANT/CONTRACTOR ...................................................... DATE......_. Sewer............ Conn. Fee $................ Water................ Meter $................ NOTE: When property validated this roan constitutes a Building Pont& This Agreement for Completion of Public Works Improvements .................. permit explma and becomes null and void should work not be cemnnenced 1s10tle Plans Checked By........ Date........ Approved By........ Date.................... 120 days from validation dab,or should authorized construction be suspended or APPLICATIONe• ELECTRICAL PERMIT abandoned for a period of 120 days atter work Is commenced. APPLICATION e. PLUMBING PERMIT INSTALLATION NO. EACH FEE Light Outlets............Switches............ PERMIT INSTALLATION NO.i EACH i FEE Fixtures............ Receptacles............ Gas Sytem with up to 5 outlets ................................... $4.00 .........••.• TOTAL NUMBER(less than 1000 watts)................. ....$ .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/$7.06.'500/1119.00 Wash. Mach..... Dishwasher.... Garb. Olsp..... .............. 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 ............. 500/$15.00 ............................................................ ............................... Urinal.... Interceptor.... Water Softener.... ...................... 4.00 ............. Signs with I XFMR ...................................... ................ 2.00 ................ Plumbing Piping without fixtures ......................�............ 4.00 ............. Eachadditional XFMR/Time Clock .. ................ .s0 ................ Misc. .................................:.:........................................................ ............. Annual Electrical Maintenance . ................25.00 ................ Permit Fee ................................ ............$ 6.00 .............................. Other see Ordinance Current) .................. .............................. .. TOTAL PLUMBING PERMIT FEE (plus penalty It app..❑) $ /.G rye[.7_........................................ ............................. ....... APPLICATION. .• HEATING/COOLING Permit Fee ........................................................................ $ 6.00 PERMIT INSTALLATION NO. EACH FEE TOTAL ELECTRICAL PERMIT FEE(plus penalty i1 app.❑) $ d0 Forced Air Unit...............to 100M ................................. $ 6.00 ..•........•••• INSPECTION e.• r over 100M ............_...... ........ 10.00 ............... Comfort Cooling Unit.....to 3 ton/HP................. .......... 6.00 .............. Forme / Foundation............................... BY:................. Date:................ to 15 ton/HP........................... 9.50 ............... Plumbing Ground Work ............................................................................ to 30 ton/HP......................... .12.00 ............... ghElectrical ........................................................................................ to 50 ton/HP.......................... 17.00 ............... AlWe - Plumbing and Heating .............................................................. Space Heater........ Wall Heater ......................................6.00 ............... ulation /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 S ........................................................................ 8.00 Final - Design Review / Landscaping .........................I--..................... TOTAL Htg./ Coolg. Permit Fee (plus penalty it app. ❑) $ Final - Public Works...........................................................