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1162 6cMcp �'so Joy• ��a� ITY OF "UPE :' I ILIO APh ICATIGN FOR COMM R61AL BUI UI G PERMIT NUMBER AND CE IFICATE OF OGGUPAN FOR APPLICANT" BUILDI 0 8 ON D V B O STREET ADDRESS OF PROJECT: r 20245..®A1IICBR®.....STE.VENS...CREEK..RO.................................. Plans Received By......._----..................................... Date ..........._.......-- Legal Description: Tract........ ............... Block............ Lot...................... REO.: Plans.... Survey.... Calcs: Struc.._. Energy.... Elect..... Mech._.. Description of Work: ......................-................--.................................. Plans Checked By.................... Date .. ... . .. 1st Struct. Improvement on Parcel:Yes.... No.... Area of Bldg............... Application Approved By.........4, L..,...._......._....Date .7/I..rO ..._. Separate Structure........._. or Addition/Alteration to Exist. Bldg........... Validated By..............................................�.r ...........Date ..:..............GG. No. of Stories................ Use of Building .................................................. Compensation Certificate Verified By../ -1`-/....... Date ...7//��6v.. Valuation of Project: $............................................................................... n s . • . . • $ - . . Owner: .....- ....._-...................._........................ Phone,. . .... Contractor: ..................._.__...._._.... City Bus.Lic. M...... Permit Fee (plus penalty if applicable) ........ ----------$............_......... Address: ...... _.................._....... . . ... Phone:.................... Plan Check Fee (less deposit of $.......... Rct. #..........)$....................... Contractor - Electrical: .............................................................................. Energy Plan Check Fee (Dep. of $.;_....,Rct. #........ $......._......_.__. Strong Motion Fee ..........CRT.V`.6U``•' .................$..... ... City Business License �'.................... Phone:................. ... Plumbing: ......_..._........_...._.......-.................._......._........ .......... Plumbing Permit Fee ... ....... $...�15"!-S'ZS City Business License #..............-... Phone:.................... Electrical Permit Fee ....... ,. .. (x. y�?�..................$..�. O..(1.. �E}� ..._ t Heating and Cooling ................/ .. . . ..... ............. Mach. Htg./Coo1g• Perml $ ...........I..................$...-............_.... City Business License #../� Phone:.r�.`.�.... Construction Tax............................�.............$........._..._..... . Architect/Designer: ....._...........................--........... Phone:.................... Sewer Conn. Fee ._._........ WateACohn. a .............$_$...._.....__.. Engineer: .... ................................................ Phone:................. Landscape Fee ..................i.. Street Tree Fee ............$..:..... Lender: .................. Misc. Fee ......._..............-._................._.. _............_.....$...:.1_ -r..`.S.__- '•I certify that in the performance of the work for which this Parrett Is • . , . ; DO CIA $ 6-qr U U Issued I shall not employ any person In any manner so as to become subject 7 twine 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 ............................ REQUIREMENTSZONING ............ I certify that as the applicant I am licensed under the provisions of the Contractors License Law and further that my License No. ............................ Environmental Status: Exempt ............ Other""' "'"""" """""" ........_............... in Classification ........................................ is In full force and effect: or .--..... Design Review Approval: Bldg. Site Sign �-��-�� I tertlly that I am exempt from the "Licensed Req. •etl" provisions oft e """ - 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.... Lead.Ste.._. correct and agree to comply with all City Ordinances and State Laws regulating Approved By.... ............... Date ...........--............ building. I (We) agree to save, indenify no ep harmless the City of Cupertino • ' • against liabilities, ludgm nis, Ste nd expenses which may in . y w y eccure against said City co qua ceof th granting of thimiLermit....................... Grant of Easement........................ SIGNATURE OF1Curb, Gutter, Sidewalk,. Driveway: Replace Repair gPPLICANT/CONTRACTOR ........... ......A.1J� Lw DATE ..... r.....Sewer............ Conn. Fee $_............. Water.__..___... Meter $..........._... NOTE: When properly valid ledthis form Constitute) , Building h. This Agreement for Completion of Public Works Improvements ......-.......... permit expires and become• ull and raid should work o be commenced within Plans Checked By........ Dale........ Approved By........ Date.................... 120 days from validation date, or should authorized eon Ion be suspended or abandoned for a period of 120 day eller work Is commenced. APPLICATION • • ELECTRICAL PERMIT APPLICATION •• PLUMBING PERMIT PERMIT INSTALLATION NO. EACH FEE Light Outlets............Switches............ PERMIT INSTALLATION NO.I EACH I FEE Fixtures............ Receptacles............ Gas Sytem with up to 5 outlets ................................---.g 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•oo ............... Lavatory.... Shower Pan.... Bathtub.... Sink........ ....... 3.00,............. 100 amp/$5.00, 200/$7.00, 500/$9.00 Wash. Mach..... Dishwasher.... Garb. Dlsp..... .............. 3.00. ............. 800/$20.00, 1200/$40.00 ................................... ................ ............... Sewer . 8.00. ............. ............................................................................. MOTORS, Generators,Welders, Heaters, Lawn Sprinkler Sys. $6.00 Ea, add Sys. $2.011.................................. per HP-KW-KVA to 1/$2.00, 5/$3.50, Vacuum Breakers ............................................ ............. 4.50 ............. 20/$6.50, 50/$10.00, 100/$12.00, .2,00 �r00 Slop Sink........ Floor Sink........ Floor Drain ................ 4.0. ............ 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.❑) $1!5,Z00 Forced Air Unit...............to loom ........................ ......... $ 6.00 ............... INSPECTION s . r over 1 OOM ............................. 10.00 ............... Comfort Cooling Unit-----to 3 ton/HP............................ 6.00 ... ...... Forms / Foundation........--.........-....... By:.................. Date:................ to 15 ton/HP........................... 9.50i..,�..�.. . 4astubing Ground Work ....................--........................ ...........-............. to 30 Nin/HP...........:.............. 12.00 ............... ughElectrical ..................................... ................................................... to 50 ton/HP.......................... 17.00 ............... me - Plumbing and Heating .......-................................................... Space Heater........ Well Heater .......................... ............6.00 ............... ulation / Energy............................... ................................................... 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. .................................................................. ............... ..... 'i...... Final - Building/Mechanical .................................................................. Permit Fee -.....-..............................................................$ 6.00 Final - Design Review / Landscaping .................................................... TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. p) $1S,M Final - Public Works........................................................... r