Loading...
1468 PERMIT NUMBER . . APPLICANT TO FILL IN STREET ADDRESS OF PROJECT: law .X4... .......................................... Plans Received By....................................................Date ......................... Legal escripti n: Tract........................ Block............ Lot...................... REO.: Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach..... Description of Work: ............................................................................... Plans Checked By Date 1st Application ApprotImprovement o ved By_...... ,... ........._Date !. -;� SeparateSt Structure or Addltion/Alteration to Exist. B/dg. ........ .. Validated By..............................................................Date ......................... No. of Stories..... ..... Use of Building .................................................. Compensation Certificate Verified By....................Date ......................... Valuation of Project: $............................................................................:... n • . . , $ Owner: . ...K /Q�zu�cwL F A.&y ............................... Phone:.................... Permit Fee (plus penalty if applicable) .............. Contractor'ria^.AN,/..G..I.M'Caa�.S City Bus.Lic. e............ ..... ..... ..........5.,3•i,-•?�.`�� Plan Check Fee (less deposit of$.......... Rctr#_.,.....)$....................... gddress: �o�4.�r.'ri'se..._:........5'r6_.. Phone........? ... Contractor --Electrical: .............................................................................. Energy Plan Check Fee (Dep. of $........ Ret. #...4_:)5�...................... City Business License #.................... Phone:.................... StrongMotion Fee .................................' - ..........$."'>='................ c:.... Plumbing: ...................................................................................... Plumbing Permit Fee � ' `�$ - -............. g ...................................1..._...+ City Business License #.................... Phone:.................... Electrical Permit Fee ...............................................`.:..:.�$L/.................... Heating and Coolie ' Mach. Ht9•/Cools• Permit $ ..............................$....................... City Business License #.................... Phone:.................... Construction Tax......................................,(...j .......... Architect/Designer: Phone:.................... ............. Sewer Conn. Fee .............. Water Conn. Fee .............: ....................... Engineer: Phone:......... Landscape fee .................... Street Tree Fee ............5....................... Lender: ....................................................................................2.Unknown ...... Misc. Fee ........................................................................$....................... ..1 certify that In the performance of the work for which this permit Is' $ Issued I shall not employ any person In any manner so of to become subject to the workmen's compensation laws of California." Type Const......... Group........ Div......... Occ. Load........ No. Exits........ SIGNATURE OF Floor Loads: 1St.... 2nd.... Other.... Sprinklered.... Area Sep. Walls.... APPLICANT/OWNER ....................................................................DATE............................ ZONING REQUIREMENTS ............ I certify that as the applicant I am licensed under the provlslons of the Contractors License Law and further that my License No. ............................ Environmental Status: Exempt............ Other....................... ........... in Classification 1Llp. +tt.............. Is In fug farce and.egect:or Design Review Approval: Bldg. Site Sign ............ certify that I em exempt from the"Licensed Rtion., " provisions o f the """"—' """"-" Contractors License Lew. mad beaus li exemption., Use Zone ............ P:D. Conditions ............................................................ I hereby acknowledge that I have reed this application and same that the above in Cond. Use Permit e...... Variance e...... Parking Spaces.... Load.Sp..... correct and agree to comply with all City Ordinances and State Laws regulating ApprovedBy........................................................... Date ........................... building. I (we) agree to save, indemnify and k harmless the City of Cupertino •" • against liabilities, judgments and expenses which may In any way accure against said CI n co uence of the granting of this permit. roachment Permit........................ Grant of Easement........................ SIGNATURE OF rb, Gutter, Sidewalk,.Driveway: Replace Repair APPLICANT/CONTRACTO ...... .. .........._...._......................... DAT§ .� _.. 4awer.............Conn. Fee $................ Water................ Meter$............... NOTE: When props sell this form consultant a Saudi P This Agreement for Completion of Public Works Improvements .................. permit expires and come null and void should work not be commenced wlWn Plans Checked By........ Date........ Approved By........ Date.................... 120 days from va dation deb, or should authorized construction be suspended or abandoned for a period of 120 days Whir work Is command. APPLICATION PLUMBING PERMIT PERMIT INSTALLATION NO. EACH FEE n Light Outlets............ Switches............ PERMIT INSTALLATION NO. EACH FEE Fixtures............ Receptacles............ Gas Sytem with up to 5 outlets ................................... $4.00 ............. TOTALNUMBER(less than 1000 watts) ....................$ .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/$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..................................... 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 Slnk........ Floor S(nk........ Floor Drain ................ 4.00 ............. 500/$15.00 ............................................................ ................ ............... Urinal.... Interceptor.... Water Softener.... ...................... 4.00 ............. Signa with I XFMR ...................................... ................ 2.00 ................ Plumbing Piping without fixtures ...................... �............ 4.00 ............. Eachadditional XFMR/Time Clock .. ................ .80 . .............. Misc. ........................................................................................I.... ............. Annual Electrical Maintenance ................25.00 .. .............. Permit Fee ..........................................................................$ 8.00 Other (See Ordinance Current) ............................................... .............. TOTAL PLUMBING PERMIT FEE (plus penalty If app. pl $ ............. n n• HEATING/COOLING APPLICATI ....................................................................................................................... Permit Fee ........................................................................ $ 6.00 PERMIT INSTALLATION NO. EACH FEE TOTAL ELECTRICAL PERMIT FEE(plus penalty If app.p) $ Forced Air Unit...............to 100M ................................. $8.00 .......•...•••• INSPECTION RECORD 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 ............... Rough Electrical ........................................................................................ to 50 ton/HP.......................... 17.00 ............... #6I:JoTU`"Energy A bng and Heating .............................................................. Space Heater........ Wall Heater ......................................8.00 ............... ............................... ................................................... Flues - other than above ..........................................:....3.00 ............... Teat .................................... ...... ................................... .......... Vent Fan: Kitchen........ Bath ..........................................3.00 ............... porary Power Oat / Elect............. Commercial Range Hood . 5.00 ............... .................................................. ............................................. Final - Electrical ........................................................................................ Misc. ...................................................................... ......... ............................ Final - Building/Mechanical .................................................................. Permit Fee ....................................................................... S 6.00 . Final - Design Review / Landscaping .................................................... TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. O) $ Final — Public Works...........................................................