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2144CITY OF CUPERTINO APPLICATION FOR COMMERCIAL BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY IF BUILDING INSPECTION DIVISION PERMIT INSTALLATION NO. EACH FEE Plans Received By ._ .............—.................___...._..., Date ....... .,......... ...... REO.: Plans.... Survey.... Calcs: Struc..... Energy.:.. Elect..... Mach..... Plans Checked By ......... ................. ...._._............ .... Date ...... .......... Application Approved By ..... ............ ......... Data Validated By... Date .....:__......�._..... Compensation Certificate Verified By .................... Date ......................... ... .., $ ,cL .,)A ....................... Permit Fee (plus penalty if applicable) ........................ $.... 5..!'!_.S'b. Plan Check Fee (less deposit of $_....._ Rct. #.........-) $..:.�.<..... ±...;?.. Energy Plan Check Fee (Dep. of $..... Rct. #........) $.._.... _........._.. Strong Motion Fee ...... ........ _.......... _.L ..... .......... ........ _. $............4=L)... PlumbingPermit Fee ...... .............................. — ...... ... $............. ......... Electrical Permit Fee ........................... ....._......... .......... $.... ._........ _.... Mach. Htg./Coolg. Permit $ .............................. $ ....................... Construction Tax ............................................. $..... .......... __... Sewer Conn. Fee .............. Water Conn. Fee .............. $_ ............... Landscape Fee .................... Street Tree Fee ............ $....................... Mist. Fee._..._..........._........__...!.......:................r.........$..............._...... Lei III $ 2 a.Xa Type Const......... Group........ Div. _...... Occ, Load........ No. Exits ....... Floor Loads: 1st.... 2nd.... Other.... Sprinklered.... Area Sep. Walls.... FX -Tv• Environmental Status: Exempt............ Other ........................................ Design Review Approval: Bldg. .._........ Site ............ Sign ..... Use Zone _..... P.D. Conditions ............. .......................... ._....... .._...... Cone. Use Permit,#...... Variance #...... Parking Spaces.... Load.,Sp..... 'Approved By ... ......_................. Date ....... ..._...... __.... PERMIT INSTALLATION NO. EACH FEE Encroachment Permit ........................ Grant of Easement................_...... . Curb, 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............ t 1.00 ........ Fixtures............ Receptacles,........... 4.00 ......... TOTAL NUMBER (less than 1000 watts),. .. ............. . $ .50 --- Range ...... -- Cooking Unit........ Oven.... ... .._.................. 2.00 ............... 3.00......... Dryer.... Garb. Disp..... 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 ..................... ... 4.50.......... MOTORS, Generators, Welders, Heaters, ' ... 4.00 ......... per HP—KW—KVA to 1/$2,00, 5/$3.50, 4.00 ...... . .. 20/$8.50, 50/$10.00, 100/$12.00, 4.00 500/$15.00 _.........._ ................................ ... .... ..... ....... ......._ ......._...... Signs with I XFMR.............._.........._......................... ... 2.00 .. .............. Each additional XFMR/Time Clock .........._.... :.. .50 ................ n1 8 Annual Electrical Maintenance .................25.00 ................ Other (see Ordinance Current) ....... _................ _.. _. _... ........... -......... _............ I...... ................... , .......... PermitFee ................................. ....... — .... ..... .................... $ 6.00 TOTAL ELECTRICAL PERMIT FEE (plus penalty if app. I]) $ Forms / Foundation ............................... By:_.— ........... Date:................ _Plumbing Ground Work......—................................................................... SoughElectrical .................... ................. ....................... ................ ..:........ rame - Plumbing and Heating ...........'r ............................... ........ .......... nsulation / Energy... ..................... ...... . ................................................... GasTest..............................................: ..........................................:.......... Temporary Power Gas / Elect..........................:.................................... Final- Electrical .... ..... ..................... ....... ........................ ........................... Final - Building / Mechanical :. ............. ........... .---------- ............................ Final - Design Review / Landscaping . ................... ..... ............. :............. Final — Public Works........................................................... PERMIT NUMBER I oZ r I- k STREET ADDRESS OF PROJECT: /f�7S.Src✓eveG.cc.c �lyo yfcurAV4 __....... ....._..... .........._........._...........................__.. Legal Description: Tract.. ..... .. ........ Block............ Lot...................... Descriptionof Work: ._ .......... ......... .__........ _...... ._........ ........................ 1st Struct. Improvement on Parcel: Yes.... No.... Area of Bldg ............... Separate Structure ...... ... ._ or Addition/ Alteration to Exist. Bldg........... No. of Stories_ ...... ....... Use of Building ... _......... ............_..................... Valuation of Project: $ .............. ............ ........... .......... ...... ___ ........ Owner:.. ...... N.0.SY'uKS.........__................... Phgne 2S....'d' a Contractor %Rpus. Lic. .... Address:.. /D /%/ L✓Cf .C'.Ll..../�.!)..... ........ Phena 4..7.': rt'.@. Contractor - Electrical: .......... .............................. .......... .................... City'Business License'# ...... __....... :.. Phone:;.'.....!..:..... i Plumbing: ...... _!......... ....f`........e: .....................-..............._......'. CBusidy, ness License #:................... Phon.................... Heating and Cooling_........................:_E......i........`................ City Business License *......... .' ...' Phone :.................... Architect/ Designer: ...... _...................... ................... Phone:.................... Engineer:...._._ ................... ....... ......... ....................... Phone:........... n noon Lender :................___.._.... _. ._.....,....._...... ...................... ._.. ............ .........._ "I certify that in th p armance of the�wor)< fo which this permit Is Issued I shall not enipjdany person in G�Iicensoef ttrr mann eo asio become subject to the workman's o pensetl SIGNATURE OF�.?� (' APPLICANT/OWNER ..... .. _._.........TE ......._............./ I certify that as the applicaprovisions of the Contractors License Law and further that my License No . ............... ............. in Classification _................. _...... —.... la in full force and effect: or I certify that I am exempt from the "Licensed Rea. •ad" provisions of the Contractors License Law. (state basis of exemption., I hereby acknowledge that I have read this application and slate that the above Is correct and agree to comply with all City Ordinances and Stale Laws regulating building. 1 (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments; hosts and expenses which may in any way acture against said City iron 6nsequ nce of the`gran[ing of this permit. SIGNATURE OF rz /,. L,' '/[/ / APPLICANT/CONTRACTOp . r'....... �i,... !..... F�. DATE .......?:........ NOTE: When properly validated this form constitutes a Building Panels. This permit expires.and becomes null and void should work not be commenced within 120 days from validation data, or should authorized construction be Wsyended or abandoned for a period of 120 days after work Is commenced. 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 Pan. . Bathtub.... Sink... ..... ......... 3.00......... Wash. Mach..... Dishwasher.... Garb, Disp................... 3.00......... Sewer.............................................................................. 8.00 Lawn Sprinkler Sys. $6.00 Ea. add Sys. $2.0Q_ ....................... Vacuum Breakers ............................................ .......... ... 4.50.......... Slop Sink........ Floor Sink........ Floor Drain ............. ... 4.00 ......... Urinal.... Interceptor.... Water Softener .......................... 4.00 ...... . .. Plumbing Piping withouE fixtures.......................�............ 4.00 Misc. . ....... ............ __ ..................................................................... . PermitFee...................................................I......................$ 6.00 TOTAL PLUMBING PERMIT FEE (Dlus Denaltv if ROD. n1 8 PERMIT INSTALLATION NO.1EACH1 FEE Forced Air Unit ............... to 100M ........................ ......"' $ 6.00 ........... over 100M ............................. 10.00 ........... Comfort Cooling Unit..... to 3 ton/HP ............................ 6.00 ........... to 15 tan/HP ........................... 9.50 ........... to 30 ton/HP .......................... 12.00 ........... to 50 ton/HP .......................... 17.00 ........... Space Heater........ Wall Heater ...................................... 8.00 ........... Flues - other than above ................................................ 3.00 ........... Vent Fan: Kitchen........ Bath .......................................... 3.00 ........... Commercial Range Hood................... 6.00 ........... Misc........................................................................................................ PermitFee ..... ....... —......................................................... $ 6.00 TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. p) $