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1875 11 ME) P LICATIgON FOR 60MMERGIAL BUILDING PERI ^' PERMIT NUMBER -7,S ANP U FOR APPLICANT TO FILL IN STREET ADDRESS OF PROJECT: C141 4011 mlil:Ksj ....64-eLlerts.....Creek.....8I.VD.............. Plans Received By............_ .................................Date ...... Legal Description: Tract.. ....... .... ....... Block............ Lot...................... REQ.: Plans.... Survey.... CaIcs: Struc..... Energy._ Elect..... Mach..... Description of Work: icr,.i........ .................................... Plans Checked By.......... ..... Date ... fat Struct. Improvement on Parcel:Yes..-- No.... Area of Bldg............... Application Approved By ...A...L t Date Separate Structure............ or Addition/Alteration to Exist. Bldg........... Validated By......__....................................._............Date ...... (............ No. of Stories....-.I......... Use of Building f2.4.t4[._S&1(1.5................... Compensation Certificate Verified By....................Date .................... Valuation,qf Project: $...... ............ ..__.............__...............:......... 10M. 111 0 , 6, $ Owner: ......__...... Phone-.yy5','ckg.nl%3Z Permit Fee (plus penalty if applicable) ...._.......... $..... ....... Contractor: ................_....__...__.._... City Bus.Lia#.......__..................... Plan Check Fee (less deposit of$.......... Rct #- $... ......... Address: .....__...........................__............................. Phone:.................... Contractor - Electrical: Vi.kent....E I.er-W.IL.......... .................... Energy Plan Check Fee (Dep. of $........ Rct. #........) ..........__ City Business Licen a #.fi-Tts.2.3..... F`hone:24r47/_1H.-.q StrongMotion Fee ........... ..._.............. ..............$...._............__. Plumbing: ... ................. .................._­....!...............:.................... Plumbing Permit Fee .... .......I...... $ I City Business License #.:_................ Phone:.................... Electrical Permit Fee ....................__..... ..i� Heating and Cooling . .........._.................................................. Mach. Htg./Coolg. Permit $ ..............................$. City Business License #.................... Phone:............-...... Construction Tax.............................................$.... Architect/Desi ner: Phone:.................... .. ................................ ............. Sewer Conn. Fee ......... .... Water Conn, Fee ...... $._...._......__-- Engineer: ...... ............. Phone: ...k......... Landscape Fee .................... Street Tree Fee $....................... . .......[�---Un nown Lender: ......__................................... .................. Misc. Fee ............_....._.....1........._..........._.........._ ..........­ "I certify that in the performance of the work for which this permit is $ 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 2-:7 ZONING REQUIREMENTSI certify that as the applicant I am licensed under the provisions of the Contractors License Law and further-that my License No.364-1.23..... Environmental Status: Exempt.......... . Other.................................... in Classification ....C..J.0......._........... is in full force and effect: or Design Review Approval: Bldg. ...._' W' ............ I certify that I am exempt from the "Licensed Feel, red" provisions of the Sign ....... Contractor. License Law. (State basis of exemption., Use Zone ............ P.D. Conditions ...... Si... . .. ...... I hereby acknowledge that I have read this application and state that the above Is Cond. Use Permit #...... Variance is....:.Vk g Spaces..... Load. Sp..... C correct and agree to comply with all City Ordinances and State Laws regulating . ... .... I building. Approved By....... .... Date ...__..............7.,) I (We) agree to save, indemnity and keep harmless the City of Cupertino • against liabl litles, judgments, costs and expenses which may in any way secure against said City in consequence qf the granting of this permit. Encroachment Permit...._............ rant of as`�nent........................ SIGNATURE OF Repair Curb, Gutter, Sidewalk, Driveway: Replac APPLICANT/CONTRACTOR ...3,Aj4....... ......... DATE 2�74-.8.1... Sewer...._._... Conn. Fee k............ star.......k, ... meter $............--.. NOTE: When properly validated this tow constitutes a Building Permit. This Agreement for Completiol N Pu J Works rovements .................. permit expires and becomes null and void should work not be commended within Plans Checked By........ Dte........ pprove y... .... Date.................... 120 days from validation date, or should authorized construction be suspended or - I abandoned for a period of 120 days after work Is commenced. APPLICATION FOR ELECTRICAL PERMIT APPLICATION FOR PLUMBING PERMIT PERMIT INSTALLA EACH FEE -10 �k Light Outlqts...1.2.... Switches... iN PERMIT INSTALLATION EACH I Ft:h Fixtures...-riS.'. Receptacles... POO Gas Sytem with up to 5 outlets ........... .... $4.00 ............. TOTAL NUMBER(less than 1000 watts)_ $ .50 Each additional outlet ...... ...... 1.00 ............. Range..mC�-. Cooking Unit..0. OvAn..:0.... ... . .... 2.00 . .............. Water System (Installation, Alt. or Repair ...i.: 4,00 ......... Dryer%i;,,Garb. Disp.&�Olshwashor...:1�07...... !6P......... 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 ............. Sewer ............_..................................__............. ......... 8.00. ..... 800/$20.00, 1200/$40.00 i ....... .......... ..... ......7P ........ MOTORS, Generators, Al SO Lawn Sprinkler Sys. $6.00 Ea, add sys. $2.OQ...................... ............. per HP-KW-KVA to 1/$2.00, 5/$3.60, Vacuum Breakers ............................................ .......... ­ 4.50 20/$6.60, 50/$10.00, 100/$12.00, Slop Sink........ Floor Sink........ Floor Drain .... ......... _ 4.00.............. 500/$15.00 JJA 4.00 1..... .)i...MR............ ......... Urinal.... Interceptor.... Water Softener.... ................... ........ Signs with I XFMR 151- 2.00 ............ -_ ­ .... . ... ... Plumbing Piping without fixtures ................................. 4.()01. Each additional XFMR/Time Clock _-.45'7__ .60 ------__... Misc. ......................................_................................. I.......................... Annual Electrical Maintenance ............ ... 25.00 .__...... Permit Fee .........................................................................$ 6.00 Other (see ordinance Current) ........ ... ............ .............. .............. TOTAL PLUMBING PERMIT FEE (plus penalty if app. p) $ ......­­............ ............­­....­..........­­. ............ ..­.......­................. APPLICATION FOR HEATING/COOLING PERMIT ................................­...... ........­. .......­­ ............I...... Permit Fee ..._.................................................................. $ 6.00 PERMIT INSTALLATION NO. EACH FEE TOTAL ELECTRICAL PERMIT FEE (plus penalty if app.I]) $ I?4.3,0•D,, Forced Air Unit...............to 100M ....... " $ 6.00 ............... 1111100MENINERU112111MOAM Amun I. over 100M .................... ........ 10.00 ............... I , Comfort Cooling Unit.....to 3 ton/HP..........I.............­.. 6.00 ............... Forms / Foundation.....__......... .......... By:.................. Date:......... to 15 ton/HP ...................... 9.50 ............... (Onimbing Ground Work ............_.......... ......................................... to 30 ton/HP..........................12.00 __.......... ughElectrical ........................................................................... ......... to 50 ton/HP.......................... 17.00 .............. ame - Plumbing and Heating ........... ...............................................t;; Space Heater........ Wall Heater ....................... 8.00 ............... 's"tu let!on /Energy................................................................................ Flues - other than above ..............................................3.00 .............. GasTest ......................................_......................................................:.­ Vent Fan: Kitchen........ Bath _........................ *** " 3.00 ...*.......***' Temporary Power Gas / Elect............................................................0: Commercial Range Hood ........................I........ . .......1... 6.60 ......... Final - Electrical ........................................_............................................. Misc. ..... ...­­....*...........I........ ..._.;__A­............ Final - Building/ Mechanical ...............1. ........ ......._............................ Permit Fee ..................................................................... $ 6.00 Final - Design Review / Landscaping .................................................... TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. 0) $ Final - Public Works.....:..................................................... I