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1470 (2) t � PERMIT NUMBER / d FOR APPLICANT TO FILL IN STREET ADDRESS OF PROJECT: e Plans Received By....................................................Date ......................... Legal Description: Tract........................ Block............ Lot...................... REO.: Plans.... Survey.... Calcs: Strut..... Energy:... Elect..... Mach..... Description of Work: ................................................................................ Plans Checked By.................................................—Date ..................... . tat Struct. Improvement on Parcel:Yes.... No.... Area of Bldg............... Application Approved By................. .............Date /Gr.�C/ Separate Structure............ or Addition/Alteration to Exist. Bldg........... Validated By..............................................................Date ..... .................. No. of Stories................ Use of Building ........................................—...... Compensation Certificate Verified By:.................-Date ......................... Valuation of Project: $................................................................................ e e .- • $ Owner:�41,,.�.A,<4.A..b.!y.l_S/.5.......................... Phone:.................... Permit Fee (plus penalty If applicable) $....................... Contra tor:((}}p.PF,ty.9N...ivh.4.'E.City Bus.Lic. e................................ P ty PP ) ........................ .7 Address: ...I3.c.r...1?-?.. ......3:,4A1...L.#tfa.� Phone:. Plan Check Fee (less deposit of$.......... Rct. #..........)$.......:.............. 3•i73..�� Contractor - Electrical: .............................................................................. Energy Plan Check Fee (Dap. of $........ Rct. #........)$....................... City Business License a.................... Phone:....................' StrongMotion Fee .................................I........................$----—................ Plumbing: ...................................................................................... Plumbing Permit Fee .................................I..............$.... .. Electrical Permit Fee ..................... �`'o City Business License #.................... Phone:.................... ..I..........................$.... Heating and Cooling Mach. Htg./Coolg. Permit $ .......... ...,..$................. City Business License •..................:. Phone:.................... Construction Tax........................................`:H;.$....................... Architect/Designer: Phone:.................... Sewer Conn. Fee .............: Water Conp. Foe ..............$-..................... Engineer: Phone:......... Landscape Fee .................... Street Tree Fee /...J.:/.$....................... Lender: ...................... (]_Unknown . ...............................'--........................... Misc. Fee ........................................................................$....................... '•I cart that In the performance of the work for which this permit to $ issued I shall not employ any person In any manner no m 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 ...................................................................GATE........._...... __.... • • ............ I certify that as the applicant I am licensed under the provisionof the J Contractors Ucenae�.aw and further that my Llcenes No.S. 0-VY-L Environmental Status: Exempt ............ Other.......................... In Classification..... ...../D................. Is In full foroe and enact:or .............. Design Review Approval: Bldg Site Sign ���������-� I certify that I am exempt from the "Licensed Req,'red"provisions"""""" """'-"' """""" Contractors License Law. (Slate beet$ of exemption., Use Zone ............ P.D. D..ndlfi..ns ............................................................ I hereby acknowledge that I have read this application and state that the above Is Cond. Use Permit*...... Variance M...... Parking Spaces.... Load. Sp..... correct and agree to comply with all city Ordinances and State Laws regulating ApprovedBy........................................................... Date ........................... building. I (We) agree to save, Indemnify and keep harmless the City of Cupertino •- • against liabilities, judgments, costs and expenses which may in any way ;, acture against said City In conseque of the granting of this permit. roachment Permit........................ Grant of Easement........................ SIGNATURE OF /11O rb, Gutter, Sidewalk,. Driveway: Replace Repair APPLICANT/CONTRACTOR ... .... .. ........_..._............... DATE Sewer............ Conn. Fee $................ Water................ Meter$................ NOTE: When properly Idatad orm .n.tU nes a Building Penult. This Agreement for Completion of Public Works Improvements .................. permit expires and becomes null and void should work not be mmmpancad wwo Plans Checked By........ Date........ Approved By........ Date.................... 120 drys from valldatkan data, or should authsdud construction be NWerded ar abandoned for a Period of 120 drys after work Is commenced.sulaulaaas APPLICATION FOR ELECTRICAL PERMIT PLUMBING PERMIT PERMIT INSTALLATION NO. EACH FEE APPLICATIa a• Light Outlets............ Switches............ PERMIT INSTALLATION NO. FJ1CH: -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 (Installation, Alt. or Repair) ................ 4.00 ............. Dryer....Garb. Disp..... Dishwasher.... ........ ................. 2.00 ............... Water Closet.... Water Heater.... Ld. Tray.................... 4.00 ............. SERVICE OR TEMPORARY POWER to ................. 2.00 ............... Lavatory.... Shower Pan.... Bathtub.... Sink.................. 3.00 100 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/$8.50, 50/$10.00, 100/$12.00, Slop Sink........ Floor Sink........ Floor Drain ................4.00 ............. 500/$15.00 ........................................................... ............................... Urinal.... Interceptor.... Water Softener.... ...................... 4.00 ............. Signs with I %FMR ...................................... ................ 2.00 . .............. Plumbing Piping without fixtures .................................. 4.00 ............ Each additional XFMR/Time Clock .. ................ .50 - . ............. Misc. ............................................................................................. ............. Annual Electrical Maintenance . ................25.00 ................ Permit Fee ..........................................................................$ 5.00 ( ) ................... .............. TOTAL PLUMBING PERMIT FEE (plus penalty If app. p) $ ' Other see Ordinance Current ............................. ............... .............. APPLICATIONa. as LING PERMI1 .. ...................................................................................... .................... . .. ... Permit Fee ........................................................................ $ 6.0-a-& .0� PERMIT INSTALLATION NO. EACH FEE TOTAL ELECTRICAL PERMIT FEE(plus penalty it app.p) $SS Forced Air Unit............:.to 1OOM ................................. $5.00 ............... INSPECTION .. , over 100M .................... ........ 10.00 ............. Comfort Cooling Unit.....to 3 ton/HP................. .......... 6.00 ............. Forme / Foundation............................... By:.................. Date:................ to 15 ton/HP................ . . 9.50 . .., ........ ............. Plumbing Ground Work ........................ ................................................... to 30 ton/HP..........................12.00 ............... Rough Electrical ........................................................................................ to 50 ton/HP.......................... 17.00 ............... mPlumbing and Heating .............................................................. Space Heater........ Wall Heater ......................................e.0o .. � .-------.... er than s Ie -Test ..Energy................................................................................... Vent Fan: Kitchen.......Bath ..........................................3.00 ............... Temporary Power Gas /Elect............. Commercial Range Hood 6.00 ............... Final - Electrical ........................................................................................ Misc. ........................................................................................................... Final - Building/Mechanical .................................................................. Permit Fee ........................................................................$ 6.00 Final - Design Review / Landscaping .................................................... TOTAL Htg./ Coolg. Permit Fee (plus penalty it app. p) $, Final — Public Works...........................................................