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03060195 (2) t RY OF CUPERTINO 0 CITY OF PERMIT APPLICATION FORM CUPERTINO 4VPN#. Date: 7 3 p, O S 6 3v-v3 Building Address: Svo 7-1�726?E 441UF Owner's Name: Phe#: /ice ifn PA T L�si t/ 40$1 Z :5.2- 2r1666 Contractor: License #: 67cd 7z-333 / Contact: Cupertino Business License#: � Z 3 04 / ' din Permit Info: Bld Ele t Plumb EDMech El Job scription: Idential [ �/sfg-sem 7G°7r� Commercial ❑ Sq.Ft. Floor Area- $/Sq.Ft.: Cost of Project: Occupancy Group: 1 . /_6 , OF-3 Type of Constructio . uanti Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERl Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Ener Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 ��(C..-- C�'Y OF CUPERTINO C i'� CUP TYOF O PERMIT APPLICATION FORM PN# J Date: -? Building Address: Mailing Address if different from building address): 75-Yo TiP T c�iTi ✓c� 0(� f tOi Owner's Name/:J Phone#: /fG 8C Contractor: License#: Ec-'C NtG/e-C efl-,c 5 72-33 3 / ct: Phon �/-�J ?3/- Mcf Cupertino Business License#: ContM lam / Fax:(40-) 74-3856 Building Permit Info: Bldge D Elect Plumb ❑ Mech ❑ 'Job escription: ^ Residential ❑ Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: _ Cost of Project: Occupancy Group: Type of Construction: Please check this box r oject is a second-story addition: ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1 M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax-Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1 OOOA ELECTRICAL BELEC1001 Elec 600V> I OOOA ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA I Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 22,