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1481 CITY OF CUPERTINO APPLICATION FOR COMMERCIAL BUILDING PERMIT PERMIT NUMBER /V— AND CERTIFICATE OF OCCUPANCY FOR APPLICANT TO FILL IN BUILDING INSPECTION DIVISION ^- STREET A` UP•5d:.._<._[PCK ,off_ v .... - DDRESS OF PROJECT. /7G/ { . �.... ..... .. Plans Received B Dat Y ����� ����� ������ e Lp. /..,{�etW.. Legal Description: Tract _,y�_B^lo k 1 lot.. .,... y REQ.: Plans.... Survey. Calcs Struc. .. Energy.... Elect.... Mach.... Description of Work:PlanJr" Checked Application Approved By...._ .:...Y. ��...,__.... Date -,y'll � 1st Strut. Improvement do Pardl:Yes.... No..... oNBldg......_r... __...Date Separate Structure........._:or Addition/Alteration to Exist. Bldg............ Validated By... ....................... ...............................Date ....... No. of Stories............:... Use of Buildi riff ....................._.....................:. Compensation Certificate Verified By............. ....Date __...__......._..._ Valuation of Project: $ .... ........... y $.; A-rr'o ,5fOLt _5.a.eJ._C"..eeuS..P.�_.:.t�.. ... • • • • • lk Owner: . . . k '. Phon 3 . - Contractor: .... 27,e .._......_ City Bus. C. x/J Permit Fee (Plus penalty if applicable) ::..:...................$.....` ............. Address: ......... .ryf�.��-.......r............................. Phone:.................... Plan Check Fee (less deposit of $..... .... Ret. #....__..)$..ter U,_ r:1 Contractor - Electncal: ._..... Energy'Plari Check Fee (Dep. of $........ Act. #........).$..__......... -_....._e #..................._.......... :.................... Strong Motion Fee ............._........:...... + `i.. City Business License #.................... Phone:.................... Plumbing: ..................._........_.._.................................._..... Plumbing Permit Fee $ .. ...........:. .-.-$' Cit ....... Business License #.................... Phone:.......... ... Electrical Permit Fee ....__. ..............._.........._.__....$... _....._ Heating and Cooling Mach. Htg./Coolg. Permit $ .............:...:..f......:..$....__............._.' City Business License #.____ .......... Phone:.................... Construction Tax............ ................................$..___..._.........: Architect/Designer: ... Phone:.................... Sewer Conn. Fee .. .... Water Conn. Fee _... .$.... -- ....Engineer: _..... Phone:....._... Landscape Fee .................. Street Tree Fee ...:_......$..... Unknown �n � .ice__- - Lender: ......_.._......__....__.....__....._.............._......................Q.................. Misc. Fee ........................:......_....._................r.....__......$.._. that I the rt f the k f which this II — o .......:. r"I certify e n a pe ormence a e wor or w e a perm e • $.� C�'r `•/ 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 ............................ r • • ..._...._. 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 Classtlicatlondt/...._�_'P.d..S'.At.54. is in full force and affect: or Design Review-Approval:. Bldg. . """ """"""Site Sign -- --- I certify that I am exempt from the "Licensed Req.'•ad" provisions of the "' """" .Contractors License Law. (State basis of exemption., Use Zone .......mi P.D. Conditions _......_ rki:._...._.........._............._........ I hereby acknowledge that I have read this application and state that the above Is Cond. Use Permit #...... Variance #...... Perking Spaces.... Load. Sp..... correct and agree to comply with all City Ordinances and State Laws regulating Approved By.......__...._............. Date .............. building. •. I (We) agree to save, indemnify and,keep.harm less the City of Cupertino r against liabilities, judgments, costs and expenses which may in any way ........ Grant of Easement......_............._, acture against said Oda;", sequence of the renting of this portal t. t, croflchment Permit................ + SIGNATURE OF Curb, Gutter, Sidewalk„ Driveway: Replace Repair' APPLICANT/CONTRAC .�„C. ............. �DATE�A�.L�.�....a......a Sewer............ Conn. Fee $....._..ubli. Water..........rov Meter ................:. NOTE:' When pmpedyis form coq gluts• a Building JP•rmk. This Agreement for Completion of Public Works Improvements ............._... permit expires and bee d void snows wom not bs commenead Mfhln Plans Checked By........ Date..:..... Approved By........ Date.................... . 120 days from validatloould authorized consWetion be susperMed or abandoned for a period of 120 days after work Is commenced. PERMIT INSTALLATION NO. EACH FEE APPLICATION FOR PLUMBING PERMIT Light Outlets............ Switches............ PERMITINSTALLATION NO. EACH FEE Fixtures....._..... Receptacles............ 'Gas Sytem with up to 5 outlets ............_.......__.......... $ 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 .... 2.00 . .............. 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/$6.50, 50/$10.00, 100/$12.00, SIop.Sink........ Floor Sink........ Floor Drain ................ 4. if ............. 500/$15.00 .....__....._....._...._...._...._._.-. .:......__. ...._.:....... ......._.._.. Urinal.._ Interceptor.... Water Softener._. ...._................ 4.00 ............. Sign EaclhhadditionallXFMR/Time Clock .. 2.50 .. .............. Misc.bang Piping without fixtures . �._......... 4.00 .__._........ .................................... Annual Electrical Maintenance . ................25.00 .. .............." Permit Fee ..........................................:...............................$ 6.00 Other (see Ordinance Current) ....__.......... ..::.....:..:............................._. TOTAL PLUMBING PERMIT FEE (plus penalty if app. E])' $ ............................................ APPLICATION •• HEATING/COOLING Permit Fee ..........................:........................................... $ 6.00 PERMIT INSTALLATION - 7N0. EACH FEE TOTAL ELECTRICAL PERMIT FEE(plus penalty if app.❑) $ Forced Air Unit...............to 1DOM ........... ..,.. $ 6.00 ...... .:....• •• s over 100M ............._..... 10.00 .........._... Comfort Cooling Unit.....to 3 ton/HP................. .. 6.00 ............... Forme / Foundation..roue .k ................ BY:..:............... Date:................ � to 15 ton/HP........................... 9.50 ............... ,illft mbin9 Ground Work ................................................. ........................... gh Electrical ................................................................................. to 301on/HP........................ .12.00 ............... ....... to 50 ton/HP.......................... 17.00 . me - Plumbing and Heating ........... ................................................... Space Heater........ Wall Heater .'........:................ ......... ...6.00 .......:....... ulTest / Ener .... - 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 ........................4......:......,........:..... ...... Permit Fee ... $ 6.00 ............................._...................................... Final - Design Review / Landscaping ._...::..:......:....:..........:.....:....i...._- TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. ❑) $ Final — Public Works.................................:.........................