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1289 PERMIT NUMBER ' FOR APPLICANT TO FILL IN STREET ADDRESS OF PROJECT: Three Oaks Park ........ _....... .........Shadaiy..Hill...@...Candlelight............ Plans Received By.................................................... Date ......................... Legal Description: Tract........................ Block............ Lot...................... REO.: Plans.... Survey.....Calcs: Struc..... ergy.... Elect..... ech..... Description of work: ...Landscape..&...Irrigation................. Plans Checked By...................... ... ........ Date /���.... Q tat Struct. Improvement on Parcel: Yes.... No....Area of Bldg............... Application Approved By. ......r........Date .. .. .. .... . <..... 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: $.......................................................................... .. • . $ Owner: Ci.ty...of..Cupertina................I......... Phonexz�..Sx.-. 'f�Q Permit Fee (plus penalty if applicable) ...................... .$......c............... Contractor: Robert.-Quatman.,City Bus. I.C.#................................ Plan Check Fee (less deposit of $.......... Rct. #..........)$................. Address: ..............................................Inc-............... Phone:.'.T$.ry-.03.5 .... Contractor - Electrical: .................... ........................................................ Energy Plan Check Fee (Dep. of $........ Rot. #........)$....................... -p Strong Motion Fee ..........................................................$....................... City Busj�ppass Licgg(�se #.................... Phone:7...1....... . Plumbing: ..iYO�er..�'..W Ua'I.tna h.r..-�.+./.Cr.:........................... Plumbing Permit Fee .................................I..............$....................... City Business License #.................... Phone:...............,.... Electrical Permit Fee ......................................................$....................... Heating and Cooling .................................................................. Mach. Htg./Coolg. Permit $ ..............................$....................... City Business License #.................... Phone:................. Construction Tax.............................................$....................... r.. Architect/Designer.: .................................................. Phone:.................... Sewer Conn. Fee .............. Water Conn. Fee ..............$....................... Engineer: Phone:......... Landscape Fee .................... Street Tree Fee ............$....................... Lender: ................._..................................................................2.Unknown Misc. Fee ........................................................................$....................... ............ "I certify that In the performance of the work for which this perml0a, • . , . : $ issued I shall not employ any person In any manner so as to become subject to the workman' c p9l9n,,1;Wo1 Calilornle." Type Const......... Group........ Div......... Occ. Load........ No. Exits........ SIGNATURE OF (�Floor Loads: 1St.... 2nd.... Other.... Sprinklered.... Area Sep. Walls.... AP�P/LICANT/OWNER ......................... DATE .5T.._/.�..•NING •UIREMENTS .../\.... I certify that e e I am licensed under the proX ie'oge(��ppf q1he Contrectore License Lggw and further that my License No. G. .♦�:L A- Environmental Status: Exempt ............ Other........................................ In Classification .......Z.7n.a.Z............... is in full force and effect: or Design Review Approval: Bldg. ............ Site ............ Sign ............ I cantly that I em exempt from the "Licensed exemption., Use d" provisions of the Cacknowl d License Law. (State is application li exemption., USB Zone ............ P.D. Conditions ............................................................ I hereby acknowledge that I have reed tole appllcatlon and stale that the above Is Cond. Use Permit#...... Variance #...... Parking Spaces.... Load. Sp..... correct and agree to comply with all City Ordinances and slate Laws regulating ApprovedBy........................................................... Date ........................... building. I (we) agree to save, Indemnify and keep harmless the City of Cupertino ' •• • agaicol liabilities, judgme ta, costa eno expenses which may in any way occurs against said Clly n one enc. f the granting of this permit. Oachment Permit....................... Grant Of Easement........................ SIGNATURE OF QQ p pp/� rb, Gutter, Sidewalk,. Driveway: Replace Repair APPLICANT/CONTRACTOR .... .. ... .. .................. DATE Q...L3..D..Q.. Sewer............ Conn. Fee $................ Water................ Meter $................ NOTE: When properly vall d this form constitutes a Building ParmN. Vila Agreement for.Completion of Public Works Improvements .................. permit expires and becomes null and void should work not be commenced w17Nn Plans Checked By........ Date........ Approved By....._.. Date.................... 120 day from ventilation data, or should authorized construction be suspended or abandoned for a period of 120 days after work Is commended. APPLICATION • • ELECTRICAL PERMIT PERMIT INSTALLATION' NO. EACH FEE APPLICATION FOR PLUMBING PERMIT 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 ..................... ............................................. Sewer .................................................................... ..... 8.00. MOTORS, Generators,Welders, Heaters, Lawn Sprinkler Sys. $6.00 Ea, add Sys. $2.o0...J... ........................... per HP—KW—KVA to 1/$2.00, 5/$3.50, Vacuum Breakers ............................................ ............. 4.50 ............. 20/$6.60, 50/$10.00, 100/$12.00, Slop Sink........ Floor Sink........ Floor Drain ................ 4.00 ............. 500/$15.00 ............................................................ ............................... Urinal.... Interceptor.... Water Softener.... ...................... 4.00 ............. Signs with I XFMR ....................................... ................ 2.00 Plumbing Piping without fixtures ....................._......... ... 4.00 ............. Each additional XFMR/Time Clock .................... .50 .. .............. Misc.........................................................................1111.......... .......................... Annual Electrical Maintenance ............. ...25.00 .. .............. Permit Fee ..........................................................................$ 6.00 Other (see Ordinance Current) ......s........._............ _.............. ......._..... TOTAL PLUMBING PERMIT FEE (plus penalty if app. p) $ .. ........ ............................................................................... ....................... . ... Permit Fee ........................................................................ $ 9.00 PERMIT INSTALLATION NO. EACH FEE TOTAL ELECTRICAL PERMIT FEE(plus penalty If app.❑) $ Forced Air Unit...............to 100M ................................. $ 6.00 .............. INSPECTION RECORD over t00M .................... ........ 10.00 .............. Comfort Cooling Unit..._to 3 ton/HP............................ 6.00 ............... Forms / Foundation.............................. By:.................. Date:................ to 15 ton/HP........................... 9.50 . Plumbing Ground Work ......................... .... ............................................. to 30 ton/HP................ ..........12.00 ............... ughElectrical ..................................... ..............................:.................... to SO ton/HP.......................... 17.00 ............... e - Plumbing and Heating .............................................................. Space Heater........ Wall Heater ......................................9.00 ............... latlon /Energy................................................................................... Flues - other than above ................................................3.00 ............... sTest ................................................................................................... Vent Fan: Kitchen........ Bath ................ ............3.00 ............... Temporary Power Gas / Elect..................................... Commercial Range Hood „9.00 Final - Electrical ........................................................................................ Misc. ............................................................................... .......-----.............. . Final - Building/Mechanical ...........:...................................................... Permit Fee ........................----..............:............................ $ 6.00 Final - Design Review / Landscaping .................................................... TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. p) $ Final — Public Works........................................................... ENCLOSED IS PLUMBING PERMIT APPLICATION FOR WORK WE ARE DOING FOR THE CITY OF CUPERTINO AT THREE OAKS PARK IN CUPERTINO. I UNDERSTAND THE FEE IS WAIVED ON THIS. IS THAT CORRECT? ROBERT QUATMAN, INC. D �C L�/ 1 � � ( + Jor,ja Kirk, Bkkpr I �