1626 PERMIT NUMBER
FOR APPLICANT TO FILL IN
STREET ADDRESS OF PROJECT:
................. ........M... ............VAILLC.0...................
4_
Plans Received By....................................................Date ............... Legal Description: Tract........./ .... .... Block............ Lot......................
REQ.; Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach...., Description of Work: ....I 41tfrt I-01K...............................................
Plans Checked By-..................1: .....P ................Date tat Struct. Improvement on Parcel: Yes.... No.... Area of Bldg...............
Application Approved By.............
'sass y Dole Separate Structure............ or Addition/Alteration to Exist. Bldg...........
Validated By..............................................................Date ............-.......... No. of Stories................ Use Rf Building ..................................................
Compensation Certificate Verified By....................Date ......................... Valuation of Project: $........&.S/00.ip6a............................... .......
$ LE'"m Owner:16&V.4S0..03&--.1-4067?
.0.4..... Ph7ne:
Permit Fee (plus penalty if applicable) ........................$... Contractord.011A- %1AY.A1fT,<4P,$, it Bus.L �;Vk
Add 7A N,�0 614 W Y,CA 04441.1-CA... P0�M-.3.7?...q/Jc
Plan Check Fee (less deposit of$.......... Rct. #..........)$..................... Contrast'.
- Electrical: ..............................................................................
Energy Plan Check Fee (Dep. of $........ Rct. #........)$.................. City Business License e.................... Phone:....................
Strong Motion Fee .............................................-.....-$ .7
........ ,-JPT Plumbing: ......................................................................................
Plumbing Permit Fee ................................................$.....I......V.. City Business License #.................... Phone:....................
Electrical Permit Fee ......................................................$...... Heating and Cooling ..................................................................
Mach. H[ /Cool Permit $ .............................. City Business Pcense #- -.-- ii! Phone: ................
Construction Tax.............................................$....................... Architect/Designer: X4J4/..J?,E1F...............OV. -PhOne:I V. .Y.37.0,0
Sewer Conn. Fee .............. Water Conn. Fee ..............$....................... Engineer: ............ ...z..........................**....*"***' Phone:.................
Landscape Fee .................... Street Tree Fee ............$-.................... Lender: ..JU.0Ja.I:F...............................................................❑0.....Tnqn
Misc. Fee .......................................................................$......../.. ......... ............ "I certify that in . "I ..1.��work for which this permit hi-
�ssuecl I shall n ploy any n:4 manner se=to become subject
Io
the workman's co pens awe of California."
Type Const......... Group........ Div......... Occ. Load........ No. Exits........ SIGNATURE OF.
APPLICANT/OWNER
0"m
.... Area Sep. Walls.... IME
Floor Loads: tat.... 2nd.... Other.... Sprinklered '>R .- ...............................................DATE ................
ZONING REQUIREMENTS Ice ,r
that as the applicant I am licensed under the no of the
Contractors License Law and further that my License No pmho/93...
Environmental Status: Exempt------..... Other....................................... In Claasi�icatlon ......P../.................... is in full fares art . .1 r
Design Review Approval: Bldg. ............ Site ............ Sign ............ ...... I certify that I a a,. train the "Licensed Req. ad" pmlslons of the
Contractors License Law. (State basis of exemption.,
Use Zone ............ P.D. Conditions ............................................................ I hereby acknowledge that I have mad this application and state that the above Is
Cond. Use Permit a...... Variance •...... Parking Spaces.... Load.Sp..... correct and agree to comply with all City Ordinances and State La" regulating
ApprovedBy-........................................-.............. Date .......................... building.
I (We) agree to save, Indemnify and keep h leas the City of Cupertino
against liabilities, judgment sts an xpenses which may In any way
�u
roachment Permit........................ Grant of Easement........................ occurs against Id Q y u a of the Bre of this permit.
SIGNATURE OF`Nlt� F=
41b, Gutter, Sidewalk, Driveway; Replace Repair APPLICANT/CO)rbas Tv
V If 9 lown comart
Sewer............ Conn. Fee $................ Water................ Meter $................ NOTE; Whom property slid '�9. IF comadlitutars a Bund This
Agreement for Completion of Public Works Improvements .................. permit expires and becomes null and void .nova work rot M owmlanoed
7
Wfiffil,
supponalso
Plans Checked By........ Date........ Approved By........ Date.................... 120 days from validation date, or should authortood constructions be suspended for
abandoned for a period of 120 days affor work Is cottonwood.
APPLICATION FOR ELECTFIICAL�FIMIT I
PERMIINSTALLATION NO. EACH a77E-E APPLICATION FOR PLUMBING PERMIT
Light Outlets.... ......Switches........3.. PERMIT INSTALLATION N
Fixtures-- ---- Receptacles.....te 1 0 Gas Sytem with up to 5 outlets .......................... ........ $4.00 .............
'2 0. . , .5 0 . /!P. �
TOTAL N&BER(less than 10 Owats),. . ... Each additional outlet ........................................... 1.00. .............
Range........Cooking Unit........Oven........... ........sass.... 2.00 ............... Water System (installation, Alt. or Repair) . 4.00 ...
Dryer.... Garb. Disp...-- Dishwasher.... --..................... 2.00 ............... Water Closet.... Water Heater]. Ld. Tray............./sass. 4.00
SERVICE OR TEMPORARY POWER to .........sass sass 2.00 .......... Lavatory.... Shower Pan.... Bathtub.... Sink......_.......... 3.00..............
100 amp/$5.00, 200/$7.00, 500/$9.00 Wash. Mach..... Dishwasher....Garb.
. Disp..- ..."'. sass.
-. 3.00
..
'
800/$20.00. 1200/$40.00 .................................. .............................. Sewer J.... 8.00. a... ...............................�.'....
MOTORS,Generators,Welders,Heaters, Lawn Sprinkler Sys. $6.00 Ea. add Sys. $2.00....................... .............
per HP-KW-KVA to 1/152.00, 5/$3.60, Vacuum Breakers .....................Flo-................
-i.ink Sink...........Flo-o-r-- ":'o
20/$6.50, 50/$10.00, 100/$12.00, Slop Sink........ Floo"r" 6��in..... 4
500/$15.00 ............................................................ ........................ Urinal.... Interceptor... Water Softener. ... ....... 4.00
Signs with I XFMR ...................................... /....sass 2.00 Plumbing Piping without fixtures ....... 4.00
............ ...........
Each additional XFMR/Time Clock . ...... 50 -.............. Misc. ........................................................ .........I.............
-......... ..
Annual Electrical Maintenance 25.00 ................
......... Permit Fee ..........................................................................$ 8.00
of r (see OrWdigrice Curvet .... ............. ........... TOTALPLUMBING PERMIT FEE (plus penalty If app. 01 lli"14.00
Will ?4
............. ........... 4
APPLICATION FOR HEATING/COOLING PERMIT
Permit Fee ........................................................................ $ 6.00 PERMIT INSTALLATION NO. EACH FEE
TOTAL ELECTRICAL PERMIT FEE(plus penalty if app.0) $,2,0C� Forced Air Unit...............to 100M ................................. $ 8.00 ...............
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 ...............
ugh Electrical ............................... ............................................... to 50 ton/HP.......................... 17.00 ...............
Une - Plumbing and Heating .............................................................. Space Heater........ Wall Heater .......................... ............6.aO ...............
ulation /Energy.................................................................................... Flues - other than above ................................................3.00 ...............
isTest ................................................. ................................................... Vent Fan: Kitchen........ Bath ...............****.....*......... 3.00 ...............
Temporary Power Gas / Elect............................................................... Commercial Range Hood .................................. 6.00 ...............
Final - Electrical ..................................... ................................................... Misc. .......................................................'*..
I
.*"'*.......... ...... ......
Final - Building/Mechanical ............... ................................................... Permit Fee ....................................".................................. 6.00
Final - Design Review / Landscaping I........................I........................... TOTAL Htl Coo1g. Permit Fee (Puspenalty If app. [:1) It
Final - Public Works...........................................................