1324 PERMIT NUMBER /3-),;71
1 , . APPLICANT TO FILL IN
STREET ADDRESS OF PROJECT:
Aqo oo..........SiewV—r....Gu��....��..................................
Plana RaCelved By...............:....................................Date ......................... Legal Description: Tract.. ..... . ... Block............ Lot......................
Y Energy.... Elect..... Mach..... Description of Work: ...�S..a1T.....E.2�.9.<.PJ...-./�Ji:NR_!4.
REO.: Plana.... Survey.... Calcs: Strut..... Ener ..............
Plans Checked By....................................................Date ......................... 1st Struct. Improvement on Parcel:Yes.... No.... Area of Bldg...............
Application Approved By......................................... Date ......................... Separate Structure............ or Additlon/Alteration to Exist. Bldg...........
Validated By..............................................................Date ......................... No. of Stories................ Us§ of Building ..................................................
Compensation Certificate Verified By.................... Date ......................... ValuationQf Project: $.... B"e ..........................................................
• • •• , Owner: .161, . T. ByX.. .. . ..................... PhpQei. ................
Permit Fee (plus penalty if a c
')ib / Qs, Contractor,
dggoe ....!Q00-� City us.Lii;, e.,,P..... 6....„ ._
P Y PP ) ........................$........a........... L�37' ri
Plan Check Fee (less depOQL of$... �... Rcl. #..........)$....................... Address: . .
Energy Plan Check Fee ( f $....,,�Rct. #........)$....................... Contractor - Electrlcal: .............................................................................
n
City Business License «.................... Phone:....................
Strong Motion Fee ......... t�_......:.'ri.................$-..........a.S...... Plumbing: ............................
Plumbing Permit Fee ..........................................................
...........
...............:. a.............$......................
City Business license e.................... Phone:....................
Electrical Permit Fee ....... ''9 ....................$....................t. Heating and Coolie
............ .
9 9 ..................................................................
Mach. Htp./Coolij. Permit t' $......................
,/....... ......... ....... City Business License «.................... Phone:....................
Construction Tex...............:... . . . . $—.................... Architect/Designer: .................................................. Phone:....................
Sewer Conn. Fee .............. Water�nn. Fee ••• ••••• 5....................... Erigineer: ................... . -• Phone:......... .....
Landscape Fee .................... Street Tree Fee ............$...................... dN�-............................................. Unknown
P Lender: .........�.....................................................................�..................
.
Misc. Fee ........................................................................$...... .c.G....� •.I certify that In the performance of the work for which this permit Is
• • ; $ 4 a Issued I shall not employ any portion In any manner so as to become subject
to the workmen's compensation laws,of California."
Type Const......... Group........ Div......... OCC. Load........ O. Exits........ SIGNATURE OF
Floor Loads: 1st.... 2nd.... Other.... Sprinklered.... Area Sep. Wells.... APPLICANT/OWNER .....-............................................................. DATE......................_.
ZONING , ............ I certify that as the applicant I em licensed under the D��vvtj)ons of the
Contractors License }.aw,�99n further that my License No. .3l1../..�.�..._...
Environmental Status: Exempt............ Other....................... in Classification ....._ ...7.¢�.................. Is in full force and effect: or
.Sign
............
Design Review Approval: Bldg. ............ Site ........... Sign I certify that I en exempt from the "Licensed Req. ed"" provlalons of the
"""""' Canlmetore License Lew. (State bels of exemption.,
Use ZOOa ............ P.D. Conditions ................. ...
....... ................................. I hereby acknowledge that I have reed this application and stere that the aboro is
Cond. Use Permit •...... Variance e...... Parking Spaces.... Load. Sp..... correct and agree to comply with all City ordinances and State Lewd regulating
ovedBy...........................:............................... Date ........................... building.
I (Wel agree to save, Indemnify and keep harmless the City of Cupertino
•• • against liabilities, judgments,coats and expenses which may In any way
°i acture against said City In consequence of the granting of this permit.
oachment Permit........................ Grant of Easement........................ SIGNATURE OF
Gutter, Sidewalk, Driveway: Replace Repair APPLICANT/CONTRACTOR ... ...... :.:.04 .d DATE
Sewer............ Conn. Fee $................ Water................ Meter $................ NOTE: When property valld til• some coroututM a Building permit. This
Agreement for Completion of Public Works Improvements .................. permit expires and became null and void should won, not be commereoed edible
Plans Checked By........ Date........ Approved By........ Date.................... ,120 days from validation data, or should authorised censbYctisn be suspended or
abandoned for a period of 120 days after won,Is commenced.
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 ..............................:.....$4.00 ••••• ••
TOTALNUMBER(lessthan 1000watts).....................$ .50 .............. Each additional outlet ............................................ 1.00 .............
Range........Cooking Unit........ Oven........... ................. 2.00 ............... Water System (Installation, Alt. or Repair) ................ 4.00 •...•........
Dryer....Garb.VISO..... 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/$8.00 Wash. Mach..... Dishwasher....Garb. Disp.....I.............. 3.00 .............
800/$20.00, 1200/$40.00 ................................. ............................... Sewer . 8.00. .............
.................................................................... ........
.
MOTORS,Generators,Welders,Heaters, Lawn Sprinkler Sys. $6.00 Ea. add Sys. $2.00......... ..........................
per AP—KW—KVA to 1/$2.00, 5/E3.50, Vacuum Breakers ............................................ ............. 4,50
20/111 60/$10.00, 100/$12.00, Slop Sink........ Floor Sink........ Floor Drain ................ 4.00 .............
500/$15.00 ............................................................ ............................... Urinal.... Interceptor.... Water Softener.... ...................... 4.00 .............
Signs with I XFMR ...................................... ................ 2.00 ................ Plumbing Piping without fixtures ......................�.............4.00...............
Each additional XFMR/Time Clock .. ................ .50 ................ Misc. ........................................................................
Annual Electrical Maintenance . ................25.00 ................ Permit Fee ..........................................................................$ 6.00 -
Other (see Ordinance Current) .................. .............................. .............. TOTAL PLUMBING PERMIT FEE (plus penalty if app. p) $
.............. APPLICATION •. HEATING/COOLING
.......................................................................................................................
Permit Fee ........................................................................ $ 6.00 PERMIT INSTALLATION NO. EACH FEE
TOTAL ELECTRICAL PERMIT FEE(plus penalty if app.p) $ Forced Air Unit...............to 100M........................ ......... $ 6.00 —............
• • •• , over 100M ............................. 10.00 ..............
Comfort Cooling Unit.....to 3 ton/HP.........r...............- 6.00�...............
Forms / Foundation............................... By:.................. Date:................ to 15 ton/HP........................... 8.60 ...............
bing Grou ld Work ............................. ............................................. to 30 ton/HP......................... .12.00 ...............
InElectrical ........................................................................................ to 50 ton/HP................ .......... 17.00 ...............
Is - Plumbing and Heating ..............................................................
ation /Ener Space Heater.. Wall Heater ......................................6.00 ...............
.._ OY............................... .................................................... Flues - other than
above ................................................3.00 ...............
Test .................................................................................................... Vent Fan: Kitchen........ Bath ..........................................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. p) $
Final — Public Works............:..............................................