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1475 (2) PERMIT NUMBER FOR APPLICANT TO FILL IN STREET ADDRESS OF PROJECT: 'T M-T 317, ....... . .............. at soya Plans Received By & -- I............Date Legal Description: Tract........................ Block............ Lot...................... RED.: Plans.... Su,"�� Energy.... Eledt..-. ec Description of Work: .................................... .. . ................................ 0 _ Plans Checked By ..... .......------Date . 1st Struct. Improvement on Parcel:Yes.... No....Area of Bldg............... 0 Application Approv�eiBy'...............X'.­.'.C---........Date Separate Structure............ or Addition/Alteration to Exist. Bldg........... Validated By.............................................................. No. of Stories................ Use of Building ................................................. Compensation Certificate Verified By. ............. Date ................ ....... Valuation of Project: $.. ............................................................................. $ a 0 a 0—'. owner:14W."&P-: AU4064 4�ry1�13honeZ6SV0% $ Contractor:46411CW6.41! ��T!... City Bus.Lic.#................................ Permit Fee (plus penalty If applicable) ..... ..... .... ... .....**.....­ J. Address: ................................................-................... Phone:.................... Plan Check Fee Irt. *.......... $... ........... Contractor - Electrical: ............................................................................ Energy Plan Check Fee (Dep. of $........ Rct. #........) $.............. City Business License *.................... Phone:.................... StrongMotion Fee ........................................ .................$..... 4......... - Plumbing: ...................................................................................... Plumbing Permit Fee ....... .........................:..............$....................... City Business License #................... Phone:.................... Electrical Permit Fee ............................. ........ Heating and Cooling .........................................w........................ . ............$.... ...... .... . Mach. Htg./Coolg. Permit $ ....................Z..........$...r................ City Business License #.................... Phone:............:....... Construction Tax...............................................$....................... Architect�q,�gr,:,F Phone:.................... Sewer Conn. Fee .............. Water Conn. Fee ......f $....................... Engineer: E'*-v%,V cMac I Av*....... Phone:.... Landscape Fee .................... Street Tree Fee ...... $.........p ..._VLender: ....................................Q..Ul....i.wii6iw.� .......... Misc. Fee ........................................................................$....................... -.......... I certify that In the performance of the work for which this permit Is -7.0 issued I&hall not employ any pawn in any manner so as to become subject o the workman's S*pensation lam of C min" Type Const......... Group........ Div......... Occ. Load........ No. Exits........ SIGNATURE OF APPLICANT/OWNE$za!?� !!!�OATE 141VIV Floor Loads: let.... 2nd.... Other.... Sprinklered.... Area Sep. Wells...- ...7�� ZONING REQUIREMENTS ............ I certify that as the applicant I am licensed under the provisions of the I Contractors License Law and further that my License No. .......................... Environmental Status: Exempt............ Other................... In Classification ....................................... Is In full fame and effect:or Design Review Approval: Bldg. ............ Site ............ Sign ............ ........ I certify that I am exempt from the "Licensed Req. ed"provisions of the Contractors License Law. (State battle 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 r...... Variance r...... Parking Spaces.... Load.Sp..... correct and agree to comply with all City Ordinances and State Law 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 accure against said City In consequence of the granting of this permit. frbclachmeril Permit_........._..._...... Grant of Easement........................ SIGNATURE OF , Gutter, Sidewalk,. Driveway: Replace Repair APPLICANT/CONTRACTOR ..................................................... DATE ................... rt ewer............ Conn. Fee $................ Water................ Meter $................ NOTE: When properly validated this form constitutes a Building Issernit. This Agreement for Completion of Public Works Improvements .................. permit expires and becomes null and void,should work rept be commenced willib Plans Checked By........ Date........ Approved By........ Date.................... 120 days from validation dale, or should authorized construction be suspended de N FOR ELECTRICAL PERMIT [,abandoned fors period of 120 days after work Isoommeencerd. APPLICATIO APPLICATION FOR PLUMBING PERMIT PERMIT INSTALLATION NO. EACH FEE Light Outlets............ Switches............ PERMIT INSTALLATION FEE- - Fixtures............ Receptacles............ Gas Sytem with up to 5 outlets .........*'***............*........ $4.00 .••-:•••.... TOTALNUMBER(lessthan 1000watts)... ......-..... .- $ .50 .............. Each additional outlet.................................I....-.... 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.OQ................................... per HP-KW-KVA to 1/$2.00. 5/$3.50. Vacuum Breakers ........................... ": 0 ............. ...­...... 0 20/$6.50, 50/$10.00, 100/$12.00, Slop Sink........ Floor Sink........ Floor ................4.00 ............. 500/$15.00 ............................................... ................ .............. Urinal.... Interceptor.... Water Softener.... ...................... 4.00 ............. ............- Plum ...................... .... . ............. Signs with I XFMR ....................................... .............. Misc.bing...........Piping without fixtures............................................................... 4 Each additional XFMR/Time Clock .................00....I............. Annual Electrical Maintenance ........... Permit Fee ..........................................................................$ 6.00 Other (see Ordinance Current) .................. .............. TOTAL PLUMBING PERMIT FEE (plus penalty if app. E]) $ 1,t4 ........................................................................ .............. APPLICATION FORHEATING/COOLING PERMIT ......................................................................... I....... Permit Fee ......... NO. M......................................................... $ 6.00 PERMIT INSTALLATION IMOFEE TOTAL ELECTRICAL PERMIT FEE(plus penalty if app.(:]) $ Forced Air Unit...............to 100M ........................ ........ $ 6.60 ............... INSPECTION RECORD over 100M .................... ........ 10.00 ............... Comfort Cooling Unit.....to 3 ton/HP............................ 8.00 ............... Forma / Foundation............................... By:.................. Date:................ to 15 ton/HP........................... 9.50............... Plumbing Ground Work ......................... ................................................... to 30 ton/HP..........................12.00 ............... RoughElectrical .................................... ................................................... to 50 ton/HP................ .......... 17.00 ............... Ia - Plumbing and Heating ........... ................................................... Space Heater........ Well Heater ......................................6.00 ;.............. ation r Teat ...Energy................................. ................................................... Vent Fan: Kitchen........ Bath ..........................................3.00 ............... Temporary Power Gas / Elect........... ................................................... Commercial Range Hood .............................................6.00 ... ........ Final - Electrical .................................... ................................................... Misc. .............................................................................................I............... Final - Building/Mechanical .............. ................................................... . Permit Fee .......................................................................$ 8-00 Final - Design Review / Landscaping 1..........:............I........................... TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. C]) $ Final - Public Works...........................................................