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1060Plans Received By ........ IV- .. ............................. Date -/. �.17. .. RED.: Plans.... Survey.... Office: Strut;..... Energy.... Elect..... Mach ..... Plans Checked By .......................... Date Application Approved By ....... Date ValidatedBy ................... .......................................... Date ............. Compensation Certificate Verified By .................... Date ......................... . a 1 $ Permit Fee (plus penalty If applicable) ........................ Plan Check Fee (less deposit of $.......... Energy Plan Check Fee (Dep. of $........ R& #........) $ StrongMotion Fee .........................................._......I...,... $­--! Plumbing Permit Fee............................ � --- .1 JL 1::, L $.'- - .............. Electrical Permit Fee ...................................................... $...................... Mach. Htg./Coolg. Permit $ .................. s.. .......... Construction Tax ................................. .......... $ ... .................. Sewer Conn. Fee .............. Water Conn. Fee .............. $....................... Landscape Fee .................... Street Tree Fee ............ $............ ....... Misc. Fee ................... .................................................... $ .... $//9r/ J? Type Const......... Group........ Div......... Occ. Load........ No. Exits Floor Loads: Tat.... 2nd.... Other.... Sprinklered.... Area Sep. Walls Environmental Status: Exempt............ Other ........................................ Design Review Approval: Bldg ............. Site ............ Sign ............ Use Zone ............ P.D. Conditions ............................................................ Cond. Use Permit #...... Variance #...... Parking Spaces.... Load. Sp..... :Droved ,o By .. , r ......................................................... Date ........................... Admk I ism 11161N`114�11111: 110111 171�1111111111111111�11 Wbachment Permit ........................ Grant of Easement........................ o Gutter, Sidewalk, Driveway: Replace Repair Sewer............ Conn. Fee $ ................ Water................ Meter $................ Agreement for Completion of Public Works Improvements .................. Plans Checked By........ Date........ Approved By........ Date .................... PERMIT INSTALLATION Light Outlets............ Switches............ Fixtures............ Receptacles............ TOTAL NUMBER (less than 1000 watts) Range........ Cooking Unit........ Oven........... Dryer.... Garb. Disp ..... Dishwasher .... ....... SERVICE OR TEMPORARY POWER to 100 amp/$5.00, 200/$7.00; 500/$9.00 800/$20.00. 1200/111 .................... MOTORS, Generators, Welders, Heaters, per HP-KW-KVA to 1/$2.00. 5/$3.50 20/$6.50, 50/$10.00, 100/$12.00. 500/$15.00 .............................................. Signs with I XFMR ...................................... Each additional XFMR/Time Clock Annual Electrical Maintenance Other (see ordinance Current) ................. NO. 1 EACH I FEE .50 2.00 2.00 2.00 2.00 -1............. .50 ............... 25.00 ................ PermitFee ........................................................................ $ 6.00 TOTAL ELECTRICAL PERMIT FEE (plus penalty if app. 0) $ Forms / Foundation.. ........................... &kmbIngBGycun1d..Work ...................... h E11of teal ..................... - .... : ... Ie - Plumbing and Heating ........ often /Energy ............................. lotion .............................................. Temporary Power Gas / Elect . ........ Final - Electrical ................................... Final - Building / Mechanical ............ Final - Design Review / Landscaping Final - Public Works ................... By: ..... * ....... * ....I Date:................ ...... ................. ............... ..... ..... PERMIT NUMBER FOR APPLICANT TO FILL IN STREET ADDRESS OF PROJECT: ..... ..................... ... .. ...... ........... ........ Legal Description: Tract.tBlock............ Lot...................... Description of Work: 4140-= ... JT"Iye,4 4.4 ...... q"5`1 7 r1f4 ...... Tat Struct. Improvement on Parcel: Yes.... No.... Area of Bldg ............... Separate Structure............ or Addition/Alteration to Exist. Bldg........... No. of Stories................ Useof Building .................................................. Valuation of Project: AZAP4-A!cf-4 .......................................................... Owner: riev.9 V-. 7 .... 9YO.Ar ........................ Phone:................... Contractor: F(RC City USAC 0...... ; 7P Address, /. 54.0 ... Rde.e Phone;,P.7.r.dW-FY Contractor - Electrical: .............................................. .......................... City Business License # .............. - .... Phone:.................... Plumbing: ... ........ ........... -- .............................................. City Business License .............. Phone:.................... Heating and Cooling .... ......................... ................................... City Business License III .................... Phone:.................... Architect/Designer:.................................. ............... Phone:.................... Engineer: ............... - .................................................. Phone:..... .. W ..... Lender: .............. ................................................................ Q ..... 11-119r ............ "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 a to become subject to the workman's compensation laws of California." SIGNATURE OF APPLICANT/OWNER ....... ............. ..................................... DATE ................ ...... .. ............ I certify that as the applicant I am licensed under the provisions of the Contractors License Law and further that my License No...........-_....... In Classification ........................................ Is In full force and effect: or ............ I certify that I am exempt from the "Licensed Req. ad" provisions of the Contractors License Law. (State basis Of exemption., I hereby acknowledge that I have road this application and state that the above 18 correct and agree to comply with all City Ordinances and State Laws regulating building. I (We) agree to save, Indemnify and keep harmless the City of.cuportino against lialal lidos, judgments, costs qnd expenses which may In any way secure against said City I onsequ a of the granting of this permit. SIGNATURE OF X APPLICANT/CONTRACTOR ............... DATE NOTE: When property valids4d this form constitudes a Building PWMIL This permit expires and becomes null and void should work not be - P Nib 120 days from validation dale, or should andivarlsed construction be suspended cer abandoned for a period of 120 clays enter vivark Ill commenced. APPLICATION FOR PLUMBING PERMIT PERMIT INSTALLATION IIINO.,EACH . FEE Gas Sytem with up to 5 outlets ................................... $4.00 ............. Each additional outlet .................................... ........... ... 1.00 ............. Water System (installation, Alt. or Repair) ...... .......... 4.00 ............. Water Closet.... Water Heater.... Ld. Tray .......... ......... . 4.00 ............. Lavatory.... Shower Pan.... Bathtub.... Sink......_.......... 3.00 .............. Wash. Mach..... Dishwasher.... Garb. DIED ..... .... ........ . 3.. 8:10 ........ 00 Sewer .................................................................... .......... 8.00 . ......... Lawn Sprinkler Sys. $6.00 Ea. add Sys. $2.00 ......... ............. .: ........... Vacuum Breakers ............................................ ... : ..... ... 4.50 1 ............. -.: ::� d:' Slop Sink........ Floor Sink........ Floor 15`r*�in ... . 4 00 ............. Urinal.... Interceptor.... Water Softener. ......... ... 4.00 ............. Plumbing Piping without fixtures ....... ......... ... 4.00 ............. Misc. .......................................... : ............. .... .... .............. ............ PermitFee .................................. ........................ $ 6.00 TOTAL PLUMBING PERMIT FEE (plus �eniiii� If app. EI) $ APPLICATION FOR HEATiNG/COOLING PERMIT PERMIT INSTALLATION NO. EACH I FEE Forced Air Unit ............... to 100M ..... .................. ......... $ 6.00............... over 100M ............................ 10.00 ............... Comfort Cooling Unit..... to 3 ton/HP ................. ......... .. 6.00 ............... to 15 ton/ HP ................ ......... .. 9.50 ............... to 30 ton/HP ................ ......... . 12.00 ..............0 to 50 tOn/HP ................ ......... . 17.00 ............... Space Heater........ Well Heater .......................... ......... ... 6.00 ............... Flues - other than above ...... 0 ............................. ......... ... 3.00 ............... Vent Fan: Kitchen........ Bath ................ ....... . . . ......... ­ 3.00 ............... Commercial Range Hood ................................. ......... ...5.00 ............... Misc. ........................................................ .............. ......... ............ ............... PermitFee ........................................................................ $ 6.00 TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. 0) $