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1469 PERMIT FOR APPLICANT TO FILL IN STREET ADDRESS OF PROJECT: ..4w......0.2......._....................................... .. Pieria Received By....................................................Date ......................... Legal Description: Tract........................ Block.......---.. Lot...................... REC.: Plans.... Survey.... CaIcs: Strut..... Energy.... Elect..... Mach...-. Description of Work: ......................................... ..... ....................... Plans Checked By.............................. --- - .............../¢-4.............-- " '- .......... ---Date I . . ........... 1st Struct. Improvement on Parcel:Yes.... No.... Area of Bldg............... Application Approved By * Date /4�� - Separate Structure..........., or Addition/Alteration to Exist. Bldg........... Validated By..............................................................Date ........................ No. of Stories................ Use of Building ................................................ Compensation Certificate Verified By.... ....Date ......................... Valuation_Qf Project: $............................................................................... �lillimly-.IILOI�- $ Owner: .,�- ....................................... Phone:.................... Permit Fee (plus penalty it applicable).........................$....................... Contractor: City Bus.Lic.#................................Address: ic.f.......-v- .;t........ Phone:.................... Plan Check Fee (less deposit of Rct. #..........)$.......... .......... Contractor - Electrical: ............................................................................. Energy Plan Check Fee (Dep. of $... Rct. #........) $.................. . - City Business License #.................... Phone:.................... StrongMotion Fee ........ .... .......�%...............................$....................... Plumbing: .................................................................................... Plumbing Permit Fee ........**............I.........$/0- �..... City Business License #.................... Phone:.................... Electrical Permit Fee ......................................................$....................... Heating and Cooling ................................................................. Mach. Htg,/Coolg. Permit $ ..............................$....................... City Business License #.................... Phone:............ Construction Tax.............................................$ .................. Architect/Desi ner: .................................................. Phone:.................... Sewer Conn. Fee .............; Water Conn. Fee ..............$....................... Engineer: ................................................................... Phone:................. Landscape Fee .................... Street Tree Fee ............$....................... Lender: .................................................................................... ..in nown . ­ ........... Misc. Fee ........................................................................$....................... ............ "I certify that in the performance of the work for which this Permit Is $ issued I shall not employ any person In any manner so a to become sublet( to the workman's compensation laws of Callfomla." Type Const......... Group........ Div......... Occ. Load........ No. Exits........ SIGNATURE OF Floor Loads: let.... 2nd.... Other.... Sprinklered.... Area Sep. Wells.... APPLICANT/OWNER -.................................................................DATE........................... ............ I certify that all the applicant I am licensed under the provision of the Contractors License Law and further that my License, No.2.1.cs.. Environmental Status: Exempt............ Other........................................ in Classification ...J5.............................Is In full force and effect:or -........- I certify that I am exempt from the "Llconsed Rtion., provisions of the Design Review Approval: Bldg. ............ Site ............ n ............ Contractors License Law. (State basis of exemption., Use Zone ............ P.D. Conditions ............................................................ I hereby acknowledge that I have mad this application and state that the above IS Cond. Use Permit#--,... Variance 0...... Parking Spaces.... Load. Sp..... correct and agree to comply with all City Ordl as and State Laws regulating ApprovedBy........................................................... Date ........................... building. I (we) agree to ke Erml-ess the City at Cupertino save, Indemnify and 1-6 against liabilities, judgment., ..at expenses which may In any way acture against said City In cons tie granting of this permit. roachment Permit........................ Grant of Easement........................ SIGNATURE OF ®rb, Gutter, Sidewalk,. Driveway: Replace Repair APPLICANT/CONTRACTOR ..... ... DATE Sewer............ Conn. Fee $................ Water................ Meter$................ NOTE: When properly v this form consatutirs a Build pe Tilde ed mull as Agreement for Completion of Public Works Improvements.................. permit expires and id void should work not h- commenced fit .. or: Plans Checked By........ Date........ Approved By........ Date.................... 120 days from valid date, or should authorized construction be enrePeitdsd W abandoned for a period of 120 days arm work Is commenced. Loinsing APPLICATION FOR PLUMBING PERMIT PERMIT INSTALLATION NO. EACH FEE Light Outlets............ Switches............ PERMIT INSTALLATION Fixtures............ Receptacles............ Gas Sytem with up to 5 outlets ........... $4.00 ..--•• TOTAL NUMBER(less than 1000watts) ... .................$ .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 ............. too 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.OQ........ ............ ............. 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 6'r'�irr ... 4.00 500/$15.00 ............................................... ... ...... Urinal.... Interceptor.... Water Softener.... ...................... 4.00 ............. Signs with I XFMR ...................................... ...... .............. Plumbing Piping without fixtures ......................1............ 4.00 ..........z Each additional XFMR/Time Clock .80 .............. Misc. ......................................................... ......................I............. Annual Electrical Maintenance ........... ---25.00 . ............. Permit Fee ..........................................................................$ 6.00 Other (see Ordinance Current) ................................ . ..... . ... ...... .............. TOTAL PLUMBING PERMIT FEE (plus penal If app....................................................................... .. ...... ..... APPLICATION FOR HEATING/COOLING PERMIT ......................................................................... .................1.*.-.'.'.--'. ......I.......... Permit Fee ...................................................................... $ 6.00 PERMIT INSTALLATION ITOX EACH ',FEE-7 TOTAL ELECTRICAL PERMIT FEE(plus penalty it app. Forced Air Unit...............to 100M ............................... $6.00 ------.:---.•• INSPECTION RECORD over 100M ............................ 10.00............... Comfort Cooling Unit.....to 3 ton/HP............................ 6.00 ............... Forme / Foundation............................... By:.................. Date:................ to 15 ton/HP........................... 9.50 Plumbing Ground Work ......................... ................................................. to 30 ton/HP..........................12.00 .............. ;&ough Electrical .................................... ................................................... to 50 ton/HP................ ..........17.00 ............... _gune - Plumbing and Heating .............................................................. Space Heater........ Wall Heater ......................................6.00 ................ latfort /Energy............................... ........................ ........................... Flues - other than above ................................................3.00 ............... aTest ................................................ ................................................... Vent Fan: Kitchen........ Bath ........................ . ........... ­-I........1-3-001................ Temporary Power Gas / Elect........... ................................................... Commercial Range Hood ......................................... ...8.001............... Final - Electrical .................................... ................................................... Misc. ........................*.....*.................*.....**'*'*....**.....**...............*........*.....*... Final - Building/ Mechanical ...........................:........... Permit Fee ........................................................................$ 6.00 Final - Design Review / Landscaping .................................................... TOTAL Htg./ Coctig. Permit Fee (plus penalty If app. 0) $ Final - Public Works...........................................................