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1943PlansReceived By .................................................... Date ......................... RED.: Plans.... Survey.... Cacs: Struc ..... Energy.... Elect..... Mach..... Plans Checked By __ ...... Application Approved By Date Date ,3 1 ValidatedBy .................................. .................. Date ......................... Compensation Certificate Verified By .................... Date ......................... $ /FO 104-0-D I" Permit Fee (plus penalty if applicable) ..................... $-F5 ....... Plan Check Fee (less deposit of $.......... Rct. #..........) $ ....................... Energy Plan Check Fee (Dep. of $........ Rct -#........) $ Strong Motion Fee .......................................................... MOTORS, Generators, Welders, Heaters, Plumbing Permit Fee ............... per HP-KW-KVA to 1/$2.00, 5/$3.50, Electrical Permit Fee - Mach. Htg./Cooig.:Pernit.................. $4...... Construction Tax.....'..-::? ................................... $....................... Sewer Conn. Fee ..... ...... * I : Water Conn. Fee .............. $....................... Landscape Fee .................... Street Tree Fee ............ $....................... Misc. Fee ... ..................................................................... - secure against Id Cit q I the ranting of this per t. �4-;x (0-0 APPLICANT/CON ...... ....... _ DATE 3� NOTE: When properly validated this farm conefflubas a Building Formal. This, Type Const......... Group...i--. Div......... Occ. Load........ No. Exits........ Floor Loads: 1st.... 2nd.... Other.... Sprinklered .... Area Sep. Walls. ZONING REQUIREMENTS PERMIT INSTALLATION NO. EACH Environmental Status: Exempt ............ Other .................................... Gas Sytem with up to 5 outlets ...................... .... ... ..... $4.00 .............. Design Review Approval: Bldg ............. Site ............ Sign ............ Use Zone ............ P.D. Conditions ............................................................ Wash. Mach..... Dishwasher.... Garb. 61SP ..... .... ......... . 3.00 ............ Cond. Use Permit e...... Variance e...... Parking Spaces.-.. Load. Sp..... 'ALP roved By ........................................................... Date ........................... Vacuum Breakers : ... . ........................... 4:1.1. ............ ..... Slop Sink........ Floor Sink........ Floor lb'r�i� 4.00 : ............ Wroachment Permit .............. .......... Grant of Easement........................ rb, 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 NO. EACH _,JNSTALLATIO� . T ............................................... Fixtures.....,... Receptacles ..... 7 "A .. ....................................... Description of Work: ... ... 1�46� TOTAL NUMBER (less than 1000 watts) $ .50 Range........ Cooking Unit........ Oven ................... ___ .... 2.00 Dryer.... Garb. Disp ..... Dishwasher......._ ... ............. .... 2.00 SERVICE OR TEMPORARY POWER to .... ........ .... 2.00 100 amp/$5.00, 200/$7.00;500/$9.00 Heating and Cooling ... ...... ......................................................... 800/$20.00, 1200/$40.00 ................. __ .......................... Engineer: .................... ........................................... Phone:........... MOTORS, Generators, Welders, Heaters, ............ "I Codify that in the performance of the work for which this permit Is per HP-KW-KVA to 1/$2.00, 5/$3.50, to 'n O'kma ' 10 rola."." 20/$6.50, 50/$10.00, 100/$12.00. I............ ...... DATE certify that as the applicant Inam licensed under the �pqii the .... 'k-clontractors License 1-jujand u or .... T_ h gsgns f 500/$15.00 ................................. ! ............ ............ ............. Signs with I XFMR ............. ......... : ... ... 2.00 '.so Each additional XFMR/Time Clock ............. Annual Electrical Maintenance.................25.00 secure against Id Cit q I the ranting of this per t. Other (see Ordinance Curren APPLICANT/CON ...... ....... _ DATE 3� FEE .................... ­ ...................................................... I..................._'- PermitFee ................................ ....................................... $ 6.00 TOTAL ELECTRICAL PERMIT FEE (plus penalty if app. C3) $.I-/, C1 0 Forms / Foundation ............................... By:_........... _&tubing un........................................................Work ........ ................ ........ ........... igh EIe2f`rica1d..... ......... I .................. ... ............... =me - Plumbing and Heating ...... .... ................... qrlotion/ Energy ............................... ................... s Test ................................................. ................... Temporary Power Gas / Elect-_ ....... ................ _ Final - Electrical ........................................................ Final - Building / Mechanical .................................. Final - Design Review / Landscaping .................... Final Public Works .. .... A...6i ....... PiO. pit 4� I Aii;it* � Date: ................ OF, CUPERTINO Ip PERMIT NUMBER FOR APPLICANT TO FILL IN ET ADDRESS OF PROJECT: . T ............................................... .A..0.. ... .. I ...... gl oq .......... Lot ...................... Legal Description* Tract 0 . .. ....................................... Description of Work: ... ... 1�46� 1st Struct. Improvement on Parcel: Yes.... No.... Area of Bldg ............... Separate Structure............ or Addition/Alteration to Exist. Bldg.../....... No. of Stories ..... I ...... ... Use ofBuildfin Valuation of. oject, $ Owner; .... _,I81. . .. ...... Phone: ................... Contractor�.4 y Bus. LIC. # .............. Address:. __, P it; . ..... ....... ...... one: Contractor - Electrical: ...................... * ........­ .. .. . .. .. ............ # City Business License .................... Phone: .................... Plumbing: ...................................................................................... City Business License # .................... Phone:.................... Heating and Cooling ... ...... ......................................................... City Buq! I Zess Ljcense # ..... ..... ... Phone:.................... Architect/ Designer: _ W Phone:.... .............. Engineer: .................... ........................................... Phone:........... cf..k­ Lender: .................................................................................... nown ............ "I Codify that in the performance of the work for which this permit Is Issued 1 Iret 0 a any manner ate, an to become subject to 'n O'kma ' 10 rola."." OF SIGNATOR 22 APPLICANT APPLICANT I............ ...... DATE certify that as the applicant Inam licensed under the �pqii the .... 'k-clontractors License 1-jujand u or .... T_ h gsgns f In Classification .......... T.,7 ....................... ie in full tome and affect: or ........ :_ I certify that I am exempt from the "Licensed Roq.',ad" provisions of the Contractors License Law. (State bale of exemption., I hereby acknowledge that I have read this application and state that the above Is correct and agree to comply with all City Ordlnanc a and State Laws regulating building. I (We) agree to save, indemnify and keep h mle a the City of Cupertino against liabilities gmen n pens a which may In any way secure against Id Cit q I the ranting of this per t. SIGNATURE OF APPLICANT/CON ...... ....... _ DATE 3� NOTE: When properly validated this farm conefflubas a Building Formal. This, perarrift expires end becomes null and void should work not be unannounced wfflo 120 days from validation date, or should authorized Construction be suspended our abandoned for a period of 120 days after work Is commenced. , . , . I APPLICATION FOR PLUMBING PERMIT PERMIT INSTALLATION NO. EACH FEE Gas Sytem with up to 5 outlets ...................... .... ... ..... $4.00 .............. Each additional outlet ............... -.1 .. ......... . 1.00 Water System (installation, Alt. or R . .. ......... . 4.00 Water Closet.... Water Heater.... Ld. Tray', -.,X .- 4.00 Lavatory.... Shower Pan.... Bathtub... Sin . 3:00 Wash. Mach..... Dishwasher.... Garb. 61SP ..... .... ......... . 3.00 ............ Sewer.................................................................... .......... 8.00 . ............. Lawn Sprinkler Sys. $6.00 Ea. add SYS. $2.00 ......... .............. ............. Vacuum Breakers : ... . ........................... 4:1.1. ............ ..... Slop Sink........ Floor Sink........ Floor lb'r�i� 4.00 : ............ Urinal.... Interceptor.... Water Softener. ......... ... 4.00 ............. Plumbing Piping wltho0 fixtures ......... ... 4.00 ............. ........ Misc. ................................................ ....... ......... .............. ............. PermitFee ..................... .................................................... $3 .0 TOTAL PLUMBING PERMIT FEE (plus penalty if app. [3) $ APPLICATION FOR HEATING/COOLING PEIIMIT PERMIT INSTALLATION NO. EACH FEE Forced Air Unit ............... to I OOM ................................. $ 6.60 ............... over 100M .­ ................ ......... 10.00 ............... Comfort Cooling Unit ..... to 3 ton/HP ............................ 6.00 ......... to 15 ton/HP ................ ......... .. 9.50 ............... to 30 ton/ HP .......................... . 12.0D ............... to 50 ton/HP ................. 1 ......... . 17.00 ............... Space Heater........ Wall Heater .......................... ......... .. 6.00 ............... Flues - other than above ....... ...................................... ... 3.00 ............... Vent Fan: Kitchen........ Bath .......... 3.00 ............ Commercial Range Hood ................... 8:00 :�� 3XX4*­ Misc . ...................... ................................................ I ......... ............ . ............ PermitFee ........................................................................ $ 6.00 TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. 0) $/0, pt -0 FwDli4 - 3 4!1 9t-0