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1352 41 � PERMIT NUMBER FOR APPLICANT TO FILL IN STREET ADDRESS OF PROJECT: Plans Received By....................................................Date ......................... Legal Description: Tra*r;" Stock............ Lot... ......... REO.: Plans.... Survey.... Cates: Struc..... Anergy.... Elect..... Mach..... Description of Work: ..................... Plans Checked By......................... ...ez... ­.....Date ...... 1st Struct. Improvement on Parcel:Yes....No....Area of Bldg............... Application Approved By.............. .... . .........Date .....q Separate Structure............ or Addition/Alteration to Exist. Bldg........... ValidatedBy..............................................................Date ......................... No. of Stories................ Use of Building .................................................. Compensation Certificate Verified By....................Date ......................... Valuation I Project: $................................. .. ...... Mllf-.IILII--l[ILOJ $ Owner: e Irs.7.................. P oneh ,It C ontracto r:—T.T. k ZrZAt44.744..,Zity Bus.Lic.0................ ............. Permit Fee (plus penalty if applicable) ........................$....................... Address: F?7........... Phone:A Plan Check Fee (less deposit of$.......... Rct #_.......)$................... Contractor - Electrical: . ............... ......... Energy Plan Check Fee (Dep. of $........ Rct. #........)$....................... City Business License #................... Phone;qz�!.:e.zr�:9 StrongMotion Fee ..........................................................$... .............. Plumbing: ........................................ Plumbing Permit Fee ........................................... ... ............. City Business License 0............... hone:....... Electrical Permit Fee ...................................... n....... 11.00..... Heating and Cooling 6,;VY. $E44771'Vx,��* Mech. Htg./Coolg. Permit $ ............... ............ ............... City Business License #.................... Phone:............I...... Construction Tax.....................................V..._'. ...I K-$.: .................. Architect/Desi ner: .................................................. Phone:.................... Sewer Conn. Fee .............. Water Conn. Fe %.%......f!'.$.........0 ....... Engineer: .................................................................... Phone:......... ...... wn Landscape Fee .................... Street Tree a ..............$_'�r.............. Lender: ...................................................................................Q .. Misc. Fee .......................................................... ....ps,................... ------ 1-1 certify that in the performance of the work for which this pournill Is Issued I shall not employ any person In any manner so a to become subject to the workman's compensation laws of California." Type Const......... Group........ Div......... Oce. Load........ No. Exits........ SIGNATURE OF Floor Loads: 1st.... 2nd.... Other.... Sprinklered.... Area Sep. Walls.... APPLICANT/OWNER .................................................................DATE ZONING REQUIREMENTS ............ 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 codify that I am exempt from the "Licensed Req, ed"provisions of the Contractors License Law. (State basis of examption., Use Zone ............ P.D. Conditions ............................................................ I hereby acknowledge that I him read this application and state that the sixive to Cord. Use Permit 0...... Variance e...... Parking Spaces.... Load.Sp----- correct and agree to comply with all City Ordinances and State Lewis regulating ApprovedBy........................................................... Date ........................... building. I I (We) agree to save, Indemnify and keep harmless the City of Cupertino [01.141 against liabilities, judgments, costs and expenses which may In any way occurs against said City In consequence of the granting of this permit. roachment Permit........................ Grant of Easement........................ SIGNATURE OF quorb, Gutter, Sidewalk, Driveway: Replace Repair APPLICANT/C I .. ............................................. DATE—------ Sewer............ Conn. Fee $................ Water................ Meter $................ NOTE: When property) this form consillubso a Sudidef; Pornit. The, Agreement for Completion of Public Works Improvements .................. permit expires and becomes null and vow should work not be tormtsrteed www Plans Checked By........ Date........ Approved By-- ---- Date............. 120 days from validation data,or should autlecurtrod construction be suspended sur abandoned for a period of 120 dap after work Is commenced. APPLICATION FOR ELECTRICAL PERMIT APPLICATION FOR PLUMBING PERMIT PERMIT INSTALLATION NO. EACH FEE Light Outlets............Switches............ PERMIT INSTALLATION NO. EACH. Fixtures............ Receptacles............ Gas Sytem with up to 5 outlets ................................ $4.00 ......... TOTALNUMBER(less than 1000 watts)... ............... $ .60 . ............ 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 Healer.... 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 r........* 3.00 .............. 800/$20.00, 11201 ..................... ............................................ 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/$3.60, Vacuum Breakers ............................................ 4:50, 20/$6.60. 50/$10.00. 100/$12.00, Slop Sink........ Floor Sink........ Floor 4 00 600/$16.00 ............................................................ ............................... Urinal.... Interceptor.... Water Softener.... .......... 4 Signs with I XFMR ...................................... ................ 2.00 _............. Plumbing Piping without fixtures ...................... Each additional XFMR/Time Clock .. ............. ... .50 . .............. Misc. ............................................................................................ ............ Annual Electrical Maintenance ................. 25.00 ................ ................... Permit Fee .................................. .............$ 6.00 Other (see Ordinanc Purrept) ............................... ................I............... TOTAL PLUMBING PERMIT FEE (plus penalty If app. 0111 4— - APPLICATION FOR HEATING/COOLING PERMIT Permit Fee ........................................................................ $ 6.00 PERMIT INSTALLATION INT. EACHFEE TOTAL ELECTRICAL PERMIT FEE(plus penalty It app.E]) If Forced Air Unit...............to 100M ........................ ........ $6.00 ............. INSPECTION RECORD over I DOM.................... ........ 10-00 ............... Comfort Cooling Unit.....to 3 ton/HP.......................... 6.00 ......... Forms / Foundation............................... BY:.................. Date:................ to 15 ton/HP.......................... 9.50 ..... Plumbing Ground Work ........................ ................................................... to 30 ton/HP............... ..........12.00 ............... ^Iugh Electrical ..................................... ................................................... to 50 ton/HP..........................17-00 ............... 0 - Plumbing and Heating .......... ........1.......................................... Space Heater........ Well Heater ......................................8.00 ............... atlon /Energy.............................. ........................ ........................... Flues - other than above ...............................................3.00 ............... WaST Test ................................................ ................................................... Vent Fan: Kitchen........ Bath .............. 3.00 ............... Temporary Power Gas / Elect........... ................................................... Commercial Range Hood ................... 8.00 ..,,- FInalFl - Electrical .................................... .................................I................. Misc. ........................................................................................................... Final - Building/Mechanical ............. ........................ ......*.................. Permit Fee ......................................................................$ 8-00 .final - Design Review / Landscaping ................................................... TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. 0) $ trial — Public Works........................................................... I