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1557 CITY O ' CUFERTINO APPLIC-ATION f0 COMMERCIAL BUILDING PERMIT PERMIT NUMBER /s S PND =� CERTIFICATE OF OCCUPANCY • ' APPLICANT TO FILL IN ESiFli nlylgiONSTREET ADDRESS OF PROJECT/?,,r-9. DEPARTMENT c Plans Received BY -f y -O'- ..Date ........._.............. Legal Description: ract ........h. ...... Block........... L t...................... REQ.: Plans.... Survey.... Cafc : truc..... Energy.... Elect.._. Mach.... Description of Work: •,/j'j.0._yc.L .LG 10 iYS............................ Plans Checked By........................... Date ........ ...... flat Struct. Improvement on Parcel:Yes.... No.... Area of Bldg............... Application Approved By................ ......�...--.....Date � .3/.1K Separate Structure............ or Addition/Alteration to Exist. Bldg........... ValidatedBy................-.........................-.................Date ..........-.............. No. of Stories................ Use of Building ................................................. Compensation Certificate Verified By......-............ Date ....._........... .... Valuati n of Pr ject. $. ..........................._.. _.._ .......r�/Tf y.aSS... Owner. '.ill,. j..[:.13AW. G'.0 *.....j'BL+:!� phoneuy/r �r c d i n G,e.a..:._. cit 3ua.a '0—................ ............/y. Jyy __... Contractor: .... .W........ ... . y Permit Fee (plus penalty it aPPlicable) ......_._............$ ..... Address: ...... ......-................. ................ Phone:.................... Plan Check Fee (less deposit of $..... Rct. #..........)$........_........._.. Contractor - Electrical: .............................................................................. Energy Plan Check Fee (Dep. of $........ Rct. #........) $..................0 City Business License *.................... Phone:.................... StronStrohMotion Fee ...:............... . ............$....... .../..... g C� ...... Plumbing: ......._................._......_......._...................................._... Plumbing Permit Fee ......_ .......CV-„e $-.....----- 9 � '-�.TIN(i��������� City Business License *.................... Phone:.................... Electrical Permit Fee ........... . ............._ ........ $__...__........_.. Heating and Cooling ��1 ................................................................. Mach. Htg./Coolg. Permit �SJ.V.....3.. y1 $ - ....... City Business License ................. Phone:.................... Construction Tax.............. 1 ......... Architect/Designer: ..73MG'j-... . ....V..F.A/ Phone:.)3.�...LA.`/ Sewer Conn. Fee .............. WAer C�onn,Fee ..............$....................... Engineer: ......—................................-.......................... Phone:......... Landscape Fee .................... tredlkTr $_.... - _.. Lender: ._.........................._...._..................................._...._:3� Unknown Mise. Fee ........._..._............._............................... ......$._.. .............. ,,,,,_.... .y certify that in the performance of the work for which this permit Is 1 • , , , ; $ �. /O Issued I shall not employ any person In any manner so as to become subject to the workmen's compensatiop laws T/ of California." Type Const......... Group........ Div......... Occ. Load........ No. Exits........ SIGNATURE OF /—pl �` -1 t Floor Loads: 1st.... 2nd.... Other.... Sprinklered.... Area Sep. Walls.... APPLICANOWNER !l .C..`R '.'. DATE . v •ZNING •UIREMENTS ............ I certify that as the applicant I am 9lcensad under the'Iprovlalona of the Contractors License Law and further that my License No. ............................ Environmental Status: Exempt ............ Other.....................ign.....—..... in Classification ............................-......... Is in full force and effect: or Design Review Approval: Bldg. Site Sign............. certify that en exempt from the "Licensed Req, ad"d" provisions o1 the —'"-- """""` Contractors License Law. (State basis o/ exemption., Use Zone ............ P.D. Conditions ............................................................ I hereby acknowledge that I have read this application and state that the above Is Cond. Use Permit *.....- Variance *...... Parking Spaces.... Load.SIP..... correct and agree to comply with all City Ordinances and State Laws regulating ApprovedBy.......-........-........................—......-..... Date ........................... building: I (We) agree to save, indemnity and keep harmless the City of Cupertino PUBLIC WORKS REQUIREMENTSagainst liabilities, judgments, costs and expenses which may in any way 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 Permit. This Agreement for Completion of Public Works Improvements .........-....... permit expires and becomes null and void should work not be commenced within Plans Checked By........ Date........ Approved By........ Date............_...... 120 days from validation dere, or Mould eulhodxed construction be suspended or abandoned for period of 120 days after work Is commenced. APPLICATION FOR PLUMBING PERMIT s • PERMIT INSTALLATION NO. EACH FEE Light Outlets............ Switches............ PERMIT INSTALLATION NO. EACH 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/$7.00, 500/$9.00 Wash. Mach..... Dishwasher.... Garb. Disp..... .......-..... 3.00 ............. 800/$20.00, 1200/$40.00 .............................................I...... ...... 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 ......—................................... .I......... ... 4.50 ............. 20/$8.50, 50/$10.00, 100/$12.00, Sop Sink........ Floor Sink........ Floor Drain ....I{1I............ 4,00 .............. 500/$15.00 -............................................. ............. ..............—.............. Urinal.... Interceptor.... Water Softener..:. ..........1............ 4.00 ............. Signs with I XFMR ....................................................... 2.00 .. .....-... Plumbing Piping without fixtures ......................JI............ 4.00 ............. - Each additional XFMR/Time Clock ... ............. ... .50 .. ....._...... Misc. .._........_......-...... .........._.....--........................................................ Annual Electrical Maintenance . .._...__.....25.00 .. .............. Permit Fee .............-....._............ . ...................................$ 6.00 Other (see Ordinance Current) .................. ..................................-.........@, TOTAL PLUMBING PERMIT FEE (plus penalty if app. ❑) S .............—............................._......—.......................__......-.........-.............. APPLICATION FOR HEATING/COOLING PERMIT ..__......_fy� Permit Fee .............................................I.......................... $ 6.00T PERMIT INSTALLATION NO. EACH FEE TOTAL ELECTRICAL PERMIT FEE(plus penalty if app.0l ) $ •-\ Forced Air Unit...........--to loom ................................. $ 6.00 .............. ON INSPECTI • , . , �I , w over 1 OOM .................... ........ 10.00 .........-4-- ,D Comfort Cooling Unit....to 3 ton/HP............................ 6.00 1............. Forms / Foundation.........—................... By:.................. Date:.......:........ v to 15 ton/HP........................... 9.50 ............... ' PlumbingGround Work ......................... ........................................-........ U to 30 ton/HP..........................12.00 ............... oughElectrical ...................................... ...............................-.................. to 50 ton/HP................ ......... . 17.00 ............... rame - Plumbing and Heating .............................................................. Space Heater........ Wall Heater .......................... ......... - 6.00 ............... J Insulation / Energy................................................................................... Flues - other than above ...................................-............3.00 ............... Gas Test ..........-........................-.............................................................. Vent Fan: Kitchen........ Bath ....-........... ....................... ... ............... Temporary Power Gas / Elect............................................................... Commercial Range Hood 6.00 ...--_-_,,,,,,. ............................................. Final - Electrical ..................................... ................................................... l Misc. —.......-........-..................................................................................... Final - Building/ Mechanical .................................................................. Permit Fee .......................................................................$ 6.00 Final - Design Review / Landscaping .................................................... TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. C]) $ Flap — Public Works.............. ...................................... �� Leo11., NAt�.1p5 1•tl•81�a WAIA. tfl.bhAE DoWq�>(,f, �•�,1 6(�\ t•N66�.w1�w,uotwvy 1-�- -61 CITY OF CUPERTINO 10300 Torre Avenue Telephone 252-4505 INSPECTION NOTICE BUILDING DIVISION JOB DATE DRESS v TIME jam` �IIWYREPDRTO CORRECTION TICE ❑ VIOLATION❑ f TYPE P.: B DG. ❑ ELE ❑ PLBG.0 MEC . C1 � i r F i WEATHER INSP.