1236 I�
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Y O F U P Rfitill�
FOR CG RC1 L BUI I PERMIT NUMBEREA ' ' APPLICANT TO FILL IN� ,. STREET ADDRESS OF PROJECT: /
Plans Received By_.........._fY. ..... Date .� Y/.. .... Legal Description: Tract...... ............-- Block............ Lot......................
REO.: Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach..... Description of Work: ........ 0!ffG."....15ZN1.`3.t..............................
Plans Checked By:-.... ........:'..........�__.1. �'yn.. Date ... ._&r..,Y�.-� let Struct. Improvement on Parcel: Yes.... NoXArea of ldg...............
Application Approved By...............C.�..':P�..�........Date .. .:................ Separate Structure........... or Addition/Alteration to Exist. Bldg...........
Validated By..................:...........-................./..,...�.....Date .. ..... No. of Stories................ Use of Buildin�....-............................................
Compensation Certificate Verified By...... ...Date ...... !_.-.-..J.. Valuation fProject: $-.-Z.0 70. .... ................ ...
• • . . � $ Owner: .. F�R..9.eS0.#..J....N1 N.5� '...CoQGL�.. Phone:-$7c,27,-y
p-a Contractor: ............5!9-./29. ...... City T�qu+¢.Lic:*................... ...
Permit Fee (Plus penalty if applicable) ...................._..$.../s?r........... Atldress: . /.Zdo.7..."-.SZY. .� 1 ...... ne
Plan Check Fee (less deposit of$....!..... Rct. #..........)$._....6.........' Contractor - Electrical: __....... ...
Energy Plan Check Fee (Dep. of $........ Rct. #........)$....................... .......#............................... :....................
...................$....................... City Business License *.................... Phone:....................
StrongMotion Fee .................._.._............... Plumbing: ......_....................._.................................. ...................
Plumbing Permit Fee ................................................$....................... City Business License #.................... Phone:....................
Electrical Permit Fee ............................!.......................$......-.. ........ Heating and Cooling
..................................................................
Mach. Htg•/Coolg. Permit $ ..............................$.-................... City Business License #_.._._........... Phone:....................
Construction Tax.............................................$......................- Architect/Designer: Phone:....................
Sewer Conn. Fee .......... Water Conn. Fee ......._.....$-.................... Engineer: Phone:........k..........
Landscape Fee .................... Street Tree Fee ............$........ . q.O .................................... ..................
Lender: ................._........... Unnown
.
Mist. Fee ......... ...__....... . . ........_.,.........._..... ... ._._....... _ "I certify that in the performance of the work for which this pennll Is
• $aa 00 issued I shall not employ any person in any manner so as to become subject
,.,.is 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 ............................
ZONING REQUIREMENTS ............ LiI certify that as the applicant I am licensed under the is a ILlgJlao be
Contractors License Law and further that my cense No. 1. 6
Environmental Status: Exempt ............ Other............... Sign
............
in Classification ..........-.....-.................... Is in full force and effect: or
Design RBVIBW Approval: Bldg. . Site Sign " certify that en exempt from the "Licensed Req, ad"tl" provlelons o/the
""""'"" '"'""""" """""" Contractors License Lew. (State basis of exemption.,
Use Zone ............ P.D. Conditions ................................. I hereby acknowledge that I have read this application and stale that the above Is
Cord. Use Permit #...... Variance #...... Perking Space ... Lo d. Sp..... correct and agree to comply with all City ordinances and State Laws regulating
provedBy....................................-............_..... Date . ................. bwtding.
// / e' I two) agree to save, Indemnity and keep harmless the City of Cupertino _
•• • two)
liabilities, judgments, casts a xpa nsee which may in any way
acture against said City in as
encs f the,granting of this permit.
/ioachment Permit........................ Grant of Ease / .._..................._ SIGNATURE OF pp pp (��1
.0 rb, Gutter, Sidewalk,. Driveway: Replace pair APPLICANT/CONTRACTOR ... ... ... . . ....... ATE Q..779!!70....
Sewer............ Conn. Fee $............... Wat r.......... star $................ NOTE: When properly vel h 11hi• form can les a Building Permit This
Agreement for Completion of Public W s Im o ments .................. permit expires and became nu and vola •heal work not be commenced WNIn
Plans Checked By........ Date........ Appr v ... Date.................... 120 day from valldMlon'd�•„pr should authorized construction be suspended or
i abandoned for a period of 120 days after work Is commenced.
APPLICATION • • ELECTRICAL PERMIT 1�
• . PLUMBING
PERMIT INSTALLATION t EACH FEE APPLICATIO
PERMIT
Ligh+ Outlets........... Switches............ PERMIT INSTA KATION NO.I EACH IFEE
Fixtures............ Receptacles...'........ Gas Sytem with upAD5.outle&;/................................ $ 4.00 ...."........
TOTAL NUMBER(less than 1000 watts) .........._....$ .50 "".....-- Each additional outlet............................................ . 1.00 .............
Range........ Cooking Unit........ Oven........... ........ .... 2.00 .. ........ Water System (InstallatiortSAlt. 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 ................................... ............................... Sewer ......... 8.00,..............
.................................................................... .
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/$6.60, 50/$10.00, 100/$12.00, Slop Sink........ Floor Sink........ Floor Drain .... ......... ... 4.00 ..............
500/$15.00 .............._.........................................._ ......-........_............ Urinal.... Interceptor.... Water Softener.... ...................... 4.00
.............
Signs with I XFMR ..................................:... ................ 2.00 .. .............. Plumbing Piping without fixtures ...................... ............ 4.00 .............
Eachadditional XFMR/Time Clock ................. ... .50 .. .............. Misc. ...........................................................................................................
Annual Electrical Maintenance ._.......-..... 25.00 .. ............. Permit Fee ..........................................................................$ 6.00
Other (see Ordinance Current) .......... ......._............ ................ .........._.. TOTAL PLUMBING PERMIT FEE"(plus penalty if app. 0) S
-............... ... ........._........ -.................._......... ..............
APPLICATION FOR HEATINGICOOLING PERMIT
.........................:............................................................. .............. .. .
Permit Fee ..........................................'............................. $ 8.00 PERMIT INSTALLATION NO. EACH FEE
TOTAL ELECTRICAL PERMIT FEE(plus penalty if app.0) $ Forced Air Unit...............to 100M -.............................. $ 6.0o
INSPECTION •. , over 100M ............................. 10.00 ...............
pq p Comfort Cooling Unit.....to 3 ton/HP............................ 6.00 ...........-"
arms / Foundation..... ld..........._... By _. _ ...... Date:R.... to 15 ton/HP........_._.............. 9.501,"",""„""""""" '
mbing Ground Work ....................:...................................................... to 30 ton/HP................ ..........12.00 ..........
gh Electrical ...................-..........:.... ................................................... to 50 ton/HP.......................... 17.00 ...............
me - Plumbing and Heating .............................................................. Space Heater........ Wall Heater .......................... ............8.00 ...............
ulatlon / Energy........................................................ ........................... Flues - other than above ............................................. ...3.00 ...............
esTest ................................................................................................-. Vent Fan: Kitchen........ Bath .-................-................ ...3.001...............
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 (plug penalty If app. 0) $
Final - Public Warks...........................................................