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1484PlansReceived By .................................................... Date ......................... REO.: Plans.... Survey.... Celcs: Struc..... Energy.... Elect..... Mach..... Plans Checked By.........................�.7 Date ........... .... .�y Application Approved By.'.....*fy..,...Gv............. Date Validated, By............................................................. Date .............../.. Compensation Certificate Verified By ...... Gc......... Date ... ••. $ II az `fesffiipo Permit Fee (plus penalty if applicable) ........................ Plan Check Fee (less deposit of $.......... Rct. #..........) $....................... Energy Plan Check Fee (Dep. of $........ Ret. #........) $....................... Strong Motion Fee ......................................................... $........../.$,70.. Plumbing Permit Fee..................:..............:..............$....................... Electrical Permit Fee............................................5.............. ......... Mach. Htg./Coolg. Permit $ ...........: ..................Is...................... Construction Tax..............................:...............$....................... Sewer Conn. Fee .............. Water Conn. Fee ............. $ ....................... Landscape Fee .................... Street Tree Fee ........... Misc. Fee ...... :................... .......................... ...:.....:.......... $.... (i........• --.r.... • $3 ��n7 Type Const......... Group........ Div.... .. Occ. Load........ No. Exits........ Floor Loads: 1st.... 2nd.... Other.... Sprinklered.... Area Sep. Walls.... Environmental Status: Exempt ........ Other ........................................ Design Review Approval: Bldg ............. Site ............ Sign ............ Use Zone ............ P.D. Conditions............................................................ Cond. Use Permit #...... 'Variance #...... Parking Spaces.... Load. Sp..... rovedBy ........................................................... Dale ........................... roachment Permit ........................ Grant of Easement........................ rb, Gutter, Sidewalk, Driveway: Replace Repair Sewer............ Conn. Fee $................ Water................ Meter $ ................ Agreement for Completion of Public Works Improvements .................. Plans Checked By........ Date........ Approved By........ Date .................... - PERMIT INSTALLATION NO. EACH FEE Light Outlets............ Switches............ Fixtures............ Receptacles............ TOTALNUMBER(lessthan 1000watts).....................$,50 . .......... Range........ Cooking Unit........ Oven ........... ................ 2.00 ........... Dryer.... Garb. Dep..... Dishwasher .... ........ ........ :.... .... 2.00 ........... SERVICE OR TEMPORARY POWER to ... 2.00 100 amp/$5.00, 200/$7.00, 500/$9.00 800/$20.00, 1200/$40.00 ............................................................ MOTORS, Generators, Welders, Heaters, per HP-KW-KVA to 1/111 5/$3.50, 20/$6.50, 50/$10.00, 100/$12.00, 500/$15.00 .............................................. ....................................... Signswith I XFMR...................................... ................ 2.00 ............ Each additional XFMR/Time Clock .. ................ .50 .. ......... Annual Electrical Maintenance ................25.00 ............ Other (see Ordinance Current) PermitFee........................................................................ $ 6.0o TOTAL ELECTRICAL PERMIT FEE (plus penalty if app. (3) $ Forms / Foundation ............................... By% ................. Date:................ bi'g Ground Work............................................................................ ghElectrical........................................................................................ z me - Plumbing and Heating........:..................................................... t�lation / Energy ............................... ........ ......... r ....... ........................... �Test.................................................................................................... Temporary Power Gas / Elect............................................................... Final- Electrical........................................................................................ Final - Building / Mechanical.................................................................. Final - Design Review / Landscaping.................................................... Final - Public Works........................................................... WE PERMIT NUMBER / � FOR APPLICANT TO FILL IN STREET ADDRESS ROJECT: . �...................... Legal Description: Tract..,/4.................. lock............ Lot...................... Description of Work: ./x' . .. ....................................................... let Struct. Improvement on Parcel: s.... No.... Area of Bldg ............... Separate Structure............ or Addition/Alteration to Exist. BIdgY......... No. of Stories ................ Use of Building .................................................. ValuationPro' h. $.:,.,... .)............................................................ Owner:.. ...- ................. ............ Phone:.......... .. ............ Contractor ..._ .... .... .. Lic. #..� . Address:/.. .1 ............._..... ...... ... Phone' �.... Contractor - Electrical: .................................�... City Business License #.................... Phone:.................... Plumbing: ...................................................................................... City Business License #.................... Phone:.................... Heatingand Cooling.................................................................. City Business License #.................... Phone:.................... Architect/Designer:.................................................. Phone:.................... Engineer: ...................................................:.:.............. Phone:........UW......... Lender: (�. nown ............ "I certify that in the performance of the work for which this permit Is Issued I shall not employ any peregill In any manner so as to become subject to the work "'a penamlon 1043 of California." SIGNATURE OF APPLICANT/OWN ...._.............._..........__........_.................. DATEI/%/ .Q ............ I certify that as the applicant I em licensed under the provisions of the Contractors License Law and further that my License No . .............. ._.......... in Classification ........................................ Is In full form and effect: or ............ I certify that I am exempt from the "Licensed Req.'•ed" provisions of the Contractors License Lew. (State basis of exemption., I hereby acknowledge that 1 have read this application and state that the above It correct and agree to comply with all Cly Ordinances and State Laws regulating building. '' I (we) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costa and explinses which may in any way acture against Bald City Inns us nce the granting of this permit. SIGNATURE OF ,, rr APPLICANT/CONTRACTO � DATE ....V ................. .. NOTE: When property validated this form consUtuW a Building Permit This permit expires and becomes null and void should work most be c mm•ncad adDrbr 120 day tram validation daft, or should Authorised construction be su lsended or abandoned for a period of 120 day of or work is commenced. APPLICATION•. PLUMBING PERMIT INSTALLATION NO. EACH FEE Gas Sytem with up to 5 outlets .......................... ......... $ 4.00 ............. Each additional outlet .................................. .......... 1.00 ............. Water System (Installation, Alt. or Repair) ................ 4.00 ............. Water Closet.... Water Heater.... Ld. Tray .................... 4.00 ............. Lavatory.... Shower Pen.... Bathtub.... Sink ....... ......... . 3.00 ............. Wash. Mach..... Dishwasher.... Garb. Disp................... 3.00 ............. Sewer.............................................................................. 8.00 ................ Lawn Sprinkler Sys. $6.00 Ea. add Sys.$2.00.................................... Vacuum Breakers ............................................ .......... ... 4.50 ............. Slop Sink........ Floor Sink........ Floor Drain .... ......... ... 4.00 ............. Urinal.... Interceptor.... Water Softener .......................... 4.00 .......... Plumbing Piping without fixtures ...................... �......... ... 4.00 ............. Misc.......................................................................................................... PermitFee.......................................................................... S 6.00 TOTAL PLUMBING PERMIT FEE (plus penalty if app. p) S APPLICATION••HEATING/COOLING PERMIT INSTALLATION NO. EACH FEE Forced Air Unit ............... to 1DOM ...................... :... ......... $ 6.00 ............... over 100M .................... ........ 10.00 .............. Comfort Cooling Unit.....to 3 ton/HP .............. I... ........... 6.00 .............. to 15 ton/HP .......................... 9.50 ............... to 30 ton/ HP ......................... 1 12.00 ............... to 50 ton/HP .................. ...... :... 17.00 ............... Space Heater........ Wall Heater ...................................... 6.00 .•............. Flues - other than above .................................... ............ 3.00 ............... VentFan: Kitchen........ Bath ..........................................3.00 ............... Commercial Range Hood „ 6.00 ............... Misc.............................................. _..................._....................................... PermitFee........................................................................ $ 6.00 TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. O) $ V