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1734 LI uF 1. Prg RE INO PP I - 10 FO COMM RCIA B LING PER T PERMIT NUMBER / 73 AND C RTI ICA E O OCC PANC FOR APPLICANT" ' FILL IN pimniyIR1 STREET ADDRESS OF PRD J�ECT' EMU, 7• a af-g,3 J 7E✓t3 c+J' e�La,k jZ✓O V4 Plans Received BY- .N/.... ......................Date L..71`. ........ Legal Description: Tract................ ._.... Block............ Lot..,................... REO.: Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach.... Description of Work: ----------- Plans Checked By.......... ...__.........Date ......... ./ 1st Struct. Improvement on Parcel: Yes.... No.... Area of Bldg............... pp y.....__.....�....�.-,......__.. Date !.. 3./lbs. Separate Structure........._. or Addition/Alteration to Exist. Bldg........... Application Approved B Validated BY.................................................... .. Date ......... <....... No. of Stories................ Use of Building .................................................. �:... 0 if Verified ......... Date ...L..�. . .. .l. .GY�l2...+2..........._.................................... Compensation CertificateBy.......... / / �. Valuation of Project:�$....,'c,� .5 , • • •• . O-0' wner: S�YN Afa�..�.. IAVIY.15._J..L094.0—........ Phone:.................... Contractor.�SI Z...IA._{QIz.1SOACity Bus. Lic. #...............__............ . Permit Fee (plus penalty if a le) ..................._.:.$..LSO............ Address: .1,3 Z0..-.Lx.. .14,I7r�-ca KK..._........... Phone:-L71' 12. Plan Check Fee (less dep it of A— Rct. #..........)$....................... Contractor - Electrical: ............. ................................................................. Energy Plan Check Fee 0/1of $....�fJrit t. #........)$......._.... .. City Business License *........_.......... Phone:.................... Strong Motion Fee ....V... j/ _..$...................... Plumbing: ..... .. ....... . ........... . . ........................... . Plumbing Permit Fee ................ .Q........$..... 1.. ---"-."'.. City Business License #.................... Phone:.................... Electrical Permit Fee ....... ..........I�e $....................... Heating and Cooling ....... ... Mach. Htg./Coolg. Permit �� $..... ......... ... City Business License #.................... Phone:.................... Construction Tax...................1J.......................$......-.............. .. Architect/Desi Designer: Phone:.................... 9 .................................................. Sewer Conn. Fee .............. Water Conn. Fee ..............$....................... Engineer: Phone:.....U..k.-...... Landscape Fee ..............—... Street Tree Fee ............$._..._.._........... Lender: ........_...._._......._ 0 nown Mise. Fee ....._................. .............. $.... . ........... "I cerilly that in the performance of the work for which this permit Is $ 96" V " 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.... Sprinklered.... Area Sep. Walls.... APPLICANT/OWNER ..............................................—.................. DATE............................ s ............ I certify that as the applicant I am licensed under the provisions of the Contractors Li a La rid fur he her at my License No. .......................... Environmental Status: Exempt..._..__. Other......................... in Classl/ieatio /..,:. ..0_�`..'a1..... Is In lull force and affect: or gn ............ Design Review Approval: Bldg. Site ............ Sign ��-�� I certify that I am exempt from the "Licensed Reg.'•ad" provisions or the """""' """"."' Contractors License Law. (State basis of exemption., Use Zone ............ P.D. Conditions ...............................:............................ I hereby acknowledge that I have read this application and state that the above Is Cond. Use Permit #... Variance #...... Parking Spaces.... Load. Sp..... correct and agree to comply with all City 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 • secure against said City nX rise uenee of the granting of this permit. ncroachment Permit...._............__ Grant of Easement......._._......._._ SIGNATURE OF Q Curb, Gutter, Sidewalk,. Driveway: Replace Repair APPLICANT/CONTRACTOR ..._ _. .�..�.. -CShG�..... DATE J.1/,"]SO Sewer............ Conn. F00 $... Water................ Meter $................ NOTE: When properly validated this form constitutes a Building Pariah. This Agreement for Completion of Public Works Improvements .................. permit expires and becomes null and void should work not be commenced within Plans Checked By........ Date........ Approved By.....-.. Date.................... 120 days from validation data, or should authorised construction be suspended or abandoned for a period of 120 days after work Is commenced. . APPLICATION FOR ELECTRICAL PERMIT PERMIT INSTALLATION NO. EACH FEE APPLICATION s R PLUMBING PERMIT Light Outlets............ Switches............ PERMIT INSTALLATION NO. EACH IFEE Fixtures............ Receptacles............ Gas Sytem with up to 5 outlets ................................... $4.00 TOTAL NUMBER(less than 1000 watts) ... ............. ... $ .50 Each additional outlet ............................................ 1.00 1............. 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 .................................. .............------------- ....... 8.00. ............. .... Sewer __........._....................................................... 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, Slop Sink........ Floor Sink........ Floor Drain .... ............ 4.00 ............. 500/$15.00 ..............................................A .. .._......................__. Urinal.... Interceptor.... Water Softener.... ........ .....:4.00 ........__. Signs with I XFMR ......._............_................ ..... 2.00 .. .............. Plumbing Piping without fixtures ...................... ....... 4.00 ............. Each additional XFMR/Time Clock .. ...._ .50 ........_._... Misc. ..............._...._...._._............................__._ ..J......... ..............I.............Annual Electrical Maintenance . .....25.00 Permit Fee ..........................................................................$ 8.00 Other (see Ordinance Current) ................_ ................... .............. TOTAL PLUMBING PERMIT FEE (plus penalty if app. 0) $................................................................... ......:........................... APPLICATION FORHEATING/COOLING PERMIT Permit Fee ..........._........................................................... $ 6.00 PERMIT INSTALLATION NO. EACH FEE TOTAL ELECTRICAL PERMIT FEE (plus penalty if app.0) $ Forced Air Unit...............to 100M ........................ ......... $ 6.00 ............... MENUMALqLLOW& over 100M ............................. 10.00 ............... ,�dd Comfort Cooling Unit....to 3 ton/HP........—................ 6.00 ............... Forms / Fcundat I' dt.. .lel...... BY: �-.. Date:... to 15 ton/HP........................... 9.50 ............... amain Plumbing a d Heating................ . ...................................... Space to 30 ton/HP................ ..........12.00 ............... �gh Electrical ... .r�.'.�1_�g(.... to 50 ton/HP.......................... 17.00 ............... Heater........ Wall Heater ......................................6.00 ............... naulation / Energy............................... .................................................... Flues - other than above .................................... ............3.00 ............... GasTest ........................................................................:........................... 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.. .. ....... ..... ..... ............................ yiAQT F9.n+we �' ...I � �r�