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1142 PERMIT NUMBER FOR APPLICANT TO FILL IN STREET ADDRESS OF PROJECT: DEPARTMENT USE ONLY s7t�7 Plans Received By.........................................:..........Date ......................... Legal Description, Tract...... ..............'Block..... Lot...................... REO.: Plans.... Survey.... Caics: Struc..... Energy.... Elect..... Mach...., Description of Work: .... ................... Plans Checked By........................ ..... Date ... 1st Struct. Improvement on Parcel:Yes.... No.... Area of Bldg............... Application Approved By...........4..1.. .... .L .. ... Date .... Separate Structure............ or Addition/Alteration to Exist. Bldg........... Validated By.............................................................Date ........................ No. of Stories................ ... U of Building ...b........................................... Compensation Certificate Verified By....................Date ......................... Valuation of Pro''act: act: N /yo 40.00-10........................... .................. Owner:,(..S .............. Phone:.N................ ractor:1,e CON A!§�,C�A.4170,F/,eg Bus.LiC. #A............... Permit Fee (plus penalty if applicable) ........................s.4-Z-00 . ..2-GA2. Phone�..X#2***-'..Arj 3 �o.i?,-#40 Address: Plan Check Fee (less deposit of$.......... Rct. #..........) .... .. .... Contractor - Electrical: ............................................................................... Energy Plan Check Fee (Dep. of $........ Rct. #........)$.......... City Business License #.................... Phone:.................... StrongMotion Fee ...........................................::-r..;..-... 1. Plumbing: ...................................................................................... Plumbing Permit Fee ................................................-V...................... City Business License 0.................... Phone:................y.. Electrical Permit Fee -.....................................I.;.;......... ............... y" Mach. Htg./CooIg. Permit $ ..................... Heating and Cooling ............................................................. ..... ..................... City Business License #.................... Phone:.................... Construction Tax.............................................$. .................... Architect/Designer; .................................................. Phone:.................... Sewer Conn. Fee .............. Water Conn. Fee ......:..S.!.......,........... Engineer: ......-............................................:.:............. Phone:........... Unknown Landscape Fee ................... Street Tree Fee ............$ Lender: ............. ................................................................. .............. ... ........... Misc. Fee ................................................... -$*.. ....... ...... "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 workman's compensation Is"of Califomla." Type Const......... Group........ Div......... Occ. Load........ No. Exits........ SIGNATi;W Floor Loads: 1st.... 2nd.,-. Other.... Sprinklered.... Area Sep. Wells.... APPLICANT/OWNER .....--.......................................................... DATE-................... ............ I carlity, that as the applicant I am licensed under the prevision of the Contractors License Law and further that my License No. .......................... in Classification ........................................ is in full form, and effect: or Environmental Status: Exempt............ Other........................................ Design Review Approval: Bldg. ............ Site ............ Sign ............ ............ I Codify that I am exempt from the "Licensed Req.*,ad" provisions of the Use Zone ............ P.D. Conditions ............................................................ Contractors License Law. (State basis of exemption., I hereby acknowledge that I have mad 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 . roved By.. ........ .............................................. Date ........................... building. I (we) agree to save, Indemnify end keep harmless the City of Cupertino against liabilities judgments,costs and eagnses which may In any way t scours against said City in cons Ce he anting of this permit. o echment Permit........................ Grant of Easement......... SIGNATURE OF P1. VbGutter, Sidewalk, Driveway: Replace Repair APPLICANT/CON 11.w- . . .. ... . DATA......................... Sewer............ Conn. Fee $................ Water................ Meter $................ NOTE: When properly valldided this farm Constitutes a Building Persell. This Agreement for Completion of Public Works Improvements .................. permit expires and becomes null and void should work not be coremaincied within Plans Checked By.....:.. Date........ Approved By........ Date.................... 120 days from validation data, or should authorized construallon bet,suspended or abandoned for a period of 120 den after work Is commenced.APPLICATION FOR ELECTRICAL PERMIT i PERMIT INSTALLATION NO. EACH FEE APPLICATION FOR PLUMBING PERMIT Light Outlets............ Switches............ PERMIT INSTALLATION NO. EACH FEE Fixtures............ Receptacles............ Gas Sytenn with up to 5 outlets ....................... ........ $4.00 .............. TOTALNUMBER(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 ................................. ............................... Sewer ....................................................... .................... 8.00. ............. MOTORS,Generators,Welders, Heaters, Lawn Sprinkler Sys. $6.00 Ea. add Sys. $2.OQ................................... per HP-KW-KVA to 1/$2.00, 6/$3.50, Vacuum Breakers ............................................ '4 .:11 ............. 20/$6.50. 50/$10.00, 100/$12.00, Slop Sink........ Floor Sink........ Floor 4.00 ............. 600/$15.00 ........................................................... ................ ............... Urinal.... Interceptor.... Water Softener.... ...................... 4.00 1............. Signs with I XFMR ....................................... .....-..... .. 2.00 ................ Plumbing Piping without fixtures ....- .........1... 4.001............. Each additional XFMR/Time Clock ... -.............. .50 . .............. Misc. ................. ............................... ...................... i- ' *.... Annual Electrical Maintenance .................25.00 . -........... Permit Fee ..........................................................................$ .00 Other (see Ordinance Current) .................. .-........................... ............... TOTAL PLUMBING PERMIT FEE (plus penalty if app. [71) $ ......................................................................... .............................. .............. APPLICATION FOR HEATING/COOLING PERMIT ........................................................................................................... .......... Permit Fee ........................................................................ $ 6.00 PERMIT INSTALLATION NO. EACH FEE TOTAL ELECTRICAL PERMIT FEE(plus penalty if app.C]) $ Forced Air Unit...............to 100M ................................. $6.00 ............... over100M .................... ........ 10.00 ............... Comfort Cooling Unit.....to 3 ton/HP................. .*......... 6.00 ............... Forme / Foundation............................... By:................... Date:................ to 15 ton/HP. . 8.50 . AWbIng round Work ............................................................................ to 30 ton/HP.................... '12.00 ............... It Electrical ........................................................................................ to 50 ton/HP............... .......... 17.00 ............... Ia - Plumbing and Heating .............................................................. Space Heater........ Wall Heater ......................................e.00 ............... teflon /Energy.................................................................................... Flues - other than above ................................................3.00 ...............Test .................................................................................................... Vent Fan: Kitchen........ Bath ..............................I.........I...3.00 ............... Temporary Power Gas / Elect............................................................... Commercial Range Hood ..............................................6.00 ............... Final - Electrical ............................................................. Misc. .......................................................................I--...I.......................... Final - Building/ Mechanical .................................................................. , Permit Fee ..........................i.................................;:.......... $ 6.00 Final - Design Review / Landscaping L........................I TOTAL Htg./ Coodg. Permit Fee (plus penalty if app. 0) $ Final - Public Works...........................................................