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1888 (2) CITY OF CUPERTINO O / CITY OF CUPERTINO f APPLICATION FOR COMMERCIAL BUILDING PERMIT FEB 10 19811 PERMIT NUMBER AND \I CERTIFICATE OF OCCUPANCY • ' / N DIX T ADDRESS OF PROJECT: a .. ............................._.. Plans Received By - _.._.... _ .... ....._. Date - ..._._.......... Legal Description: Tract ... ... Block ..... Lot ..—. . REQ.: Plans.... Survey .. Calcs' Strue. ... Energy._. Elect.. . Mach.... Description of Work"Y -_pixA /NG ... - ..._ ..... ......... Plans Checked By..........._..__........... Data .. . . . ...... tat Struct. Improvement on Parcel:Yes.... No__ Area of Bldg............... Application Approved By........_.......�-!_L1.._...._Date _. /�U��/ Separate Structure.. . p . ........ or Addition/Alteration to Exist. Bldg........... Validated By ...__........_.._....__.__.._.Date ...........__.......... No. of Stories.........._.._ Use of Building ....._...__....... ......................... Compensation Certificate Verified By . .-- Date - .. .- Valuation of P I ct. $. . -. ....... ..... ....... . • • •• • $ Owner -�. / (pE.A.ui9 �A3s1Tjf}_.. --. ... Phone .. Permit Fee lits snail If applicable) Contractor: . 6'<Ly...PV*ffWi City Byyes LIc. # 3301 [�... (P penalty PP ) - - - $ "" Address: .2. I .FlAJY0J$0_ A1JC G/1A(ff4U Phone.' .66'.S�CYJ Plan Check Fee (less deposit of $. - - _ Rct. #_ ....)$ . . ` Contractor - Electrical:Busine....._icens. Energy Plan Check Fee (Dep. of $........ Rct. #.-......) $....................... . . ..... ................ Strong Motion Fee ....._..._......._.........._...._........-.........$......... City Business License #.. ... Phone:.................... ������ Plumbing: ......... Plumbing Permit Fee ...._....--........_............_.....—.$.. City Business License #........._._.._. Phone:..........--...... Electrical Permit Fee ..................-........--....................$...._......._..... .. Heating and Cooling ..........#............................. ............ ..... Mach. Ht9•/Coolg. Permit $ ..............................$.... ..... _._..._ _. City Business License *.................... Phone:e:...............—..... Construction Tax.............................................$- ......... ........- Architect/Designer: __._._______........................... Phone:..... Sewer Conn. Fee ...—.......- Water Conn. Fee .....—...-$..................._.. Engineer: .......... Phone:....._........... --_._...._._.............._....._.... Landscape Fee .......... . Street Tree Fee ............$.................... .. Lender: .................... J� n nown �i Misc. Fee ._._......-.... ....... ._...._......__.....__.....-_---....$.... ..................' "I certify that in the performance of the work for which this permit to ,,,�,p,�:; • ,, '^:: $ issued I shall not employ any person In any manner so as to become subject to the workman's compensation laws of California." Type Const......... Group........ Div......... Occ. Load........ No. Exits._._.. SIGNATURE OF Floor Loads: 1st.... 2nd.... Other.... Sprinklered__ Area Sep, Walls.._ APPLICANT/OWNER ..................................._............................... DATE ..... • s e,;. .; ._......... I certify that as the applicant I am licensed under the provisions of the Contractors LicenAg L l f rther that my License No. .. ............. Environmental Status: Exempt _.._... Other in ClassifieatiQA. 1 .........._ Is in full force and effect: or ...... ............. Design Review Approval: Bldg. ......._... Site ............ Sign ._......._ I certify that I am exempt from the "Licensed Req,'•etl" provisions of the Use Zone .......... . P.D. Conditions Contractors Llcense Law. (State basis of exemption., ------------------ ------- I hereby acknowledge that I have read this application and.stete that the above Is Cond. Use Permit #...... Variance *...... Parking Spaces.... Load. Sp..... correct and agree to comply with all City Ordinances and State Laws regulating Approved By---........... _......__.......................... Date ..... ........... bonding. I (We) agree to save, indemnify and keep harmless the City of Cupertino • ' • '•s1. + against liabilities, judgments, costs and expenses which may in,any way Encroachment chNernt Permit........-- a Gra Grantof Easement Repair secure against said City in con nce the g ming of this permit. ••< - SIGNATURE OF /� /t. YI P P APPLICANT/CONTRACT ( .... DATE 414/9./- Sewer........__ Conn. Fee $................ Water.....__.._.. Meter $............ NOTE: When properly veli ated this form a elitutes a Building Permit. This Agreement for Completion of Public Works Improvements .................. permit expires and becomes null and void should work not be commenced within Plans Checked By........ Date........ Approved By........ pate........ 120 days from validation dale, or should authorised construction be suspended or abandoned far a period of 120 days after work Is commenced. PERMIT INSTALLATION NO. EACH FEE Light Outlets............ Switches. .... PERMIT INSTALLATION NO.I EACH I FEE Fixtures......-..... Receptacles............ Gas Sytem with up to 5 outlets ...._.._......................... $ 4.00 ............ TOTALNUMBER(lessthan 1000watts).... .............— $ .50 - -- Each additional outlet ...,:........_..._._........_. ...... 1.00 ............. Range.... Cooking Unit........ Oven............................ 2.00 . —._...._.. Water System flnstallation, Alt. or Repair) .....-.... 4.00.,,,, Ve, Dryer.... Garb. Disp...- Dishwasher.... ........ ........... . .... 2.00 ............._ Water Closet.l. Water Heater.... Ld. Tray.............�..... 4.00. SERVICE OR TEMPORARY POWER to ..............._. 2,00 . ._...._..... Lavatory/. Shower Pan.... Bathtub.... Sink........_ ...... 3.00.. ....._ O 100 amp/$5.00, 200/$7.00, 500/$9.00 Wash. Mach..... Dishwasher.... Garb. Disp..... .............. 3.00.............. 800/$20.00, 1200/$40.00 .._................. .._....._................................. 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/$3.50, Vacuum Breakers ..._....................................... . ............ 4.50.............. 20/$6.50, 50/$10.00, 100/$12.00, Slop,Sink........ Floor Sink........ Floor Drain ................ 4.00.............- 500/$15.00 -.............................._..........._ ........_._.......................__..... Urinal.... Interceptor.... Water Softens ....... _. 4.00 ............. Signs with I XFMR .........__.......... ...._......_ ........_...... 2.00 - j Plumbing Piping without fixtures .._..................�............ 4.00 J ............. Each additional XFMR/Time Clock .................... .50 _.............. Misc. ...................................._...._........-.._................._....................._......-- Annual Electrical Maintenance . ................25.00 .. .............. Permit Fee ..........................................................................$ 8,00 Other (see Ordinance Current) ........... ..............................._-_.........._ ( TOTAL PLUMBING PERMIT FEE (plus penalty if app. [J) S/(,,0(), . p , Permit Fee . --................... .. ... $ 6.00 PERMIT INSTALLATION NO. EACH I FEE TOTAL ELECTRICAL PERMIT FEE (plus penalty If app.❑) S Forced Air Unit ........to 100M ---................ $ 6.00 --- .r.,c=fr*".:... • .• • . �+, .',,. over 1oOM ...... ....... 10 00 ............. Comfort Cooling Unit.....to 3 ton/HP............................ 6.00 ............... Forms / Foundation_... ..................— By:-................ Date:................ to 15 ton/HP..._...................... 9.50 ............... Olumbing Ground Work ...... to 30 ton/HP................ .......... 12.00 ............... HughElectrical ......--...-......_............_ ..............................................-- V to 50 ton/HP................ .......... 17.00 ............... In e - Plumbing and Heating .............................................................. 1k Space Heater........ Wall Heater ......................................6.00 . sulation / Ener ..... .... 9Y....................................-.................. ........................... Flues - other than above ...................................-............3.00 ............... �das Test ......_.........................._....__.......................... .............................. S� Vent Fan: Kitchen........ Bath ...............................—...... ...3.00 ............... Temporary Power Gas / Elect.................................... ....... Commercial Range Hood ..._........ 6.00 Final - Electrical ..................-.................................................-----------....... Misc. ....----......—----.....-....-............................-..-.................................--. Final - Building/Mechanical .................................................................. Permit Fee ....................---....---....--....................................$ 6.00 Final - Design Review / Landscaping ....................-.............................. TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. p) $ Final — Public Works........................................................... v�