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1422 i IC/ PERMIT NUMBER /5e2L , . APPLICANT TO FILL IN STREET.ADDRESS OF PROJECT: DEPARTMENT USE ONLY Plena Received By..:::::.....f.).qty:..........................Date .9//,1j6....... Legal Description: Tr a�t . ....... ...... Block............ Lot...................... 9' cAEO.: Plepa.'.:: Survey--- Celcs: Strut..... orgy.... Elect..... Mach. .. Description of Work: ....... .. ........fi m.W! ......................................... Plane Checked By ::....::................ ........:..Date .. .. .. (.'`�) tat Strutt. Improvement on Parcel: Yes.'!. No.... Area of Bldg?-SYS.`.'.?./. r Application Approved ey............ .R........Date .. . ..� .IrT Separate Structure............ or Addition/Altera on to xlst. Bldg..1C...... a:r:. �/ Validated By.............................................................Date .....-.....-............. No. of Stories........2.... Use of Building f.+.•Y3.._!!I....$Zre. .................... Compensation Certificate Vprifled By....................Date ......................... Valuation of Project: $..2.L6..o...........-......................... ............................ SONYA . . . •• . Sev1/00 00 Owner:-7?!' .8.:..fifeani;rSftJ...L is ........... Phone:;..07..-.22.4� Permit Fee (plus penalty It applicable) Contractor: .......:.'......................... .... City Bus. Lic. e................................ P PP ) ........................$.'�.. .......... rf..iiae✓ p2 e Plan Check Fee (less deposit of$.......... Rot. #..........)$../S.-fv.0.. Address: .([BST...S.....:........................s+!�?_•j°`yfy.sr..... Phone:-...l.!............. Cc rector - Electrical: .............................................................................. Energy Plan Check Fee (Dep. of $... F1ct. #........)$...................... Ciry Business License #.................... Phone:.................... Strong Motion Fee ..............0._........-..........................$...........0,X.- /� Plumbin Plumbing Permit Fee $..../Q...UR... gBusi.......................................................ne:.................... ......�.T................................. City Business License e.................... Phone:.................... Electrical Permit Fee ...(i'...`....'..t:�,;..........................$....................... Heating and Cooling .................................................................. Mach. Ht9./Coolg. Perm�t,$ .;.......�;r................$....................... City Business License *.................... Phone:.................... Construction Tex..............t.... .... -i;s .............$....................... Designer:Architect/ �/� Phone:.................... n .. Fee .............. Water nn. Fee ....-.........$..................... Sewer Conn. .�, Engineer: ...... ... Phone:.......... ......................................................... Unkfiowri Landscape Fee ...............�.. Street`T,fr?e Fee ............$....., 8.... Lender: ........ . .. ---- •-••--••- Misc. Fee ..................:......:....1.......................................$.......... v. "I certify that In the performance of the work for which this permit Is MIEN § �/ 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.... .. Occ. Load........ No. Exits........ SIGNATURE OF Floor Loads: 1st.... 2nd.... Other.... Sprinkiered.... Area Sep. Walls.... APPLICANTiowNE /4../J..... .............. DATE? ...�.......... -« , • ............ I certify the as the applicant I am licensed under the provisions of the Contractors License Lew and further that my License No. ...._......__.......... Environmental Status: Exempt............ Other..................iii".-............ In Classification ........................................ Is In full tome and erect:or Design Review Approval: Bldg. Site Sign -.--........ I certify that I em exempt from the "Licensed Rtion., tl" provisions of the """" "'-"'-"" Cackno le License Law. (State owls li exemption., Use Zone ..-......... P.D. COnditiOnB ............................................................ I hereby acknowledge that I have reed this application and state that the above Is ._. Cond. Use Permit!......Variance e...... Parking Spaces.... Load.Sp..... correct and agree to comply with all Ciry Ordinances and State Laws regulating ApprovedBy........................................................... Date ........................... building. •• • I (We) agree to save. Indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs and expenses which may In any way • acture against said City in consepuen�+/1 th granting of this permit. oachment Permit........................ Grant of Easement........................ 810UATURE of 91 ? ���I rb, Gutter, Sidewalk,. Driveway: Replace Repair APPLICANTICONTRACTO ..........(�. ........ . . ....... DATE 4�41ff......... r Sewer............ Conn. Fee $................ Water................ Meter$................ NOTE: When property (dated this form coesatutes a Building ParmN. This ftfienlent for Completion of Public Works Improvements .................. permit expires and becomes null and void should work not be commanded adtldri Plebs Checked By........ Date........ Approved By........ Date.................... 120 days from validation date, or Should authoriwd consumption be suspended or abandoned for a period of 120 dajti after work Is commenead. • APPLICATION FOR PLUMBING ,Or PERMIT INSTALLATION NO. EACH FEE Light Outlets............ Switches...----..... PERMIT INSTALLATION NO.I EACH ILAGFE 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) ...............1 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 ......... 6.00. :......... ..................................................................... .. 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, Slap Sink........ Floor Sink........ Floor Drain ................ 4.00 ............. 500/$15.00 ............................................................ ............................... Urinal.... Interceptor.... Water Softener.... ..........�............ 4.00 .:........... Signs with I XFMR ...................................... ................ 2.00 ................ Plumbing Piping without fixtures ...............................-.. 4.00 ............. Each additional XFMR/Time Clock .. ............. ... .50 .. .............. Misc. ....................................................................... .... ........... ............ Annual Electrical Maintenance .................25.00 ................ Permit Fee ..........................................................................$ 6.00 Other (see Ordinance Current) ................................................ .............. TOTAL PLUMBING PERMIT FEE (plus penalty if app. 0) $ .� .......................................................................... ............................. .............. APPLICATIONs. HEATING/COOLING ......................................................................... ............................................. Permit Fee ........................................................................ $ 6.00 PERMIT INSTALLATION NO. EACH FEE TOTAL ELECTRICAL PERMIT FEE(plus penalty if app.❑) $ Forced Air Unit...............to 1DOM ................................. $ 6.00 - ----------- INSPECTION RECORD over 100M .................... ........ 10.00 .............. Comfort Cooling Unit.....to 3 ton/HP............................ 6.00 .............. Forms / Foundation............................... By:.................. Date:................ to 15Ion/HP........................... 9.50 ............... P mbing Ground Work ........................................................................... to 30 ton/HP..........................12.00 ............... h Electrical ........................................................................................ 17.00 ......._....... to 50 ton/HP......................... e - Plumbing and Heating .............................................................. Space Heater........ Well Heater .......................... ............6.00 ............... l ation / Energy............................... .. . . .. yo�sy. ty...�� Flues - other than above ................................................3.00 ............... Teat ......._........................................ .. .. li,/..r ...G[/ Vent Fan: Kitchen........ Beth ..........................................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. 0) $ Final - Public Works...........................................................