1557 (2) CITY O ' CUFERTINO
APPLIC-ATION f0 COMMERCIAL BUILDING PERMIT PERMIT NUMBER /s S
PND
=� CERTIFICATE OF OCCUPANCY • ' APPLICANT TO FILL IN
ESiFli nlylgiONSTREET ADDRESS OF PROJECT/?,,r-9.
DEPARTMENT c
Plans Received BY -f y -O'- ..Date ........._.............. Legal Description: ract ........h. ...... Block........... L t......................
REQ.: Plans.... Survey.... Cafc : truc..... Energy.... Elect.._. Mach.... Description of Work: •,/j'j.0._yc.L .LG 10 iYS............................
Plans Checked By........................... Date ........ ...... flat Struct. Improvement on Parcel:Yes.... No.... Area of Bldg...............
Application Approved By................ ......�...--.....Date � .3/.1K Separate Structure............ or Addition/Alteration to Exist. Bldg...........
ValidatedBy................-.........................-.................Date ..........-.............. No. of Stories................ Use of Building .................................................
Compensation Certificate Verified By......-............ Date ....._........... .... Valuati n of Pr ject. $. ..........................._.. _.._ .......r�/Tf y.aSS...
Owner. '.ill,. j..[:.13AW. G'.0 *.....j'BL+:!� phoneuy/r �r
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i n G,e.a..:._. cit 3ua.a '0—................ ............/y. Jyy
__... Contractor: .... .W........ ... . y
Permit Fee (plus penalty it aPPlicable) ......_._............$ ..... Address: ...... ......-................. ................ Phone:....................
Plan Check Fee (less deposit of $..... Rct. #..........)$........_........._.. Contractor - Electrical:
..............................................................................
Energy Plan Check Fee (Dep. of $........ Rct. #........) $..................0 City Business License *.................... Phone:....................
StronStrohMotion Fee ...:............... . ............$....... .../.....
g C� ...... Plumbing: ......._................._......_......._...................................._...
Plumbing Permit Fee ......_ .......CV-„e $-.....-----
9 � '-�.TIN(i��������� City Business License *.................... Phone:....................
Electrical Permit Fee ........... . ............._ ........ $__...__........_.. Heating and Cooling
��1 .................................................................
Mach. Htg./Coolg. Permit �SJ.V.....3.. y1 $ - ....... City Business License ................. Phone:....................
Construction Tax.............. 1 ......... Architect/Designer: ..73MG'j-... . ....V..F.A/ Phone:.)3.�...LA.`/
Sewer Conn. Fee .............. WAer C�onn,Fee ..............$....................... Engineer: ......—................................-.......................... Phone:.........
Landscape Fee .................... tredlkTr $_.... - _.. Lender: ._.........................._...._..................................._...._:3� Unknown
Mise. Fee ........._..._............._............................... ......$._.. .............. ,,,,,_.... .y certify that in the performance of the work for which this permit Is 1
• , , , ; $ �. /O Issued I shall not employ any person In any manner so as to become subject
to the workmen's compensatiop laws
T/ of California."
Type Const......... Group........ Div......... Occ. Load........ No. Exits........ SIGNATURE OF /—pl �` -1 t
Floor Loads: 1st.... 2nd.... Other.... Sprinklered.... Area Sep. Walls.... APPLICANOWNER !l .C..`R '.'. DATE . v
•ZNING •UIREMENTS ............ I certify that as the applicant I am 9lcensad under the'Iprovlalona of the
Contractors License Law and further that my License No. ............................
Environmental Status: Exempt ............ Other.....................ign.....—.....
in Classification ............................-......... Is in full force and effect: or
Design Review Approval: Bldg. Site Sign............. certify that en exempt from the "Licensed Req, ad"d" provisions o1 the
—'"-- """""` Contractors License Law. (State basis o/ exemption.,
Use Zone ............ P.D. Conditions ............................................................ I hereby acknowledge that I have read this application and state that the above Is
Cond. Use Permit *.....- Variance *...... Parking Spaces.... Load.SIP..... correct and agree to comply with all City Ordinances and State Laws regulating
ApprovedBy.......-........-........................—......-..... Date ........................... building:
I (We) agree to save, indemnity and keep harmless the City of Cupertino
PUBLIC WORKS REQUIREMENTSagainst liabilities, judgments, costs and expenses which may in any way
acture against said City in consequence of the granting of this permit.
Encroachment Permit.........._............ Grant Of Easement........................ SIGNATURE OF
Curb, Gutter, Sidewalk,. Driveway: Replace Repair APPLICANT/CONTRACTOR ............—......................................... DATE ............................
Sewer............ Conn. Fee $................ Water................ Meter $................ NOTE: When properly validated this form constitutes 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........ Date............_...... 120 days from validation dere, or Mould eulhodxed construction be suspended or
abandoned for period of 120 days after work Is commenced.
APPLICATION FOR PLUMBING PERMIT
s •
PERMIT INSTALLATION NO. EACH FEE
Light Outlets............ Switches............ PERMIT INSTALLATION NO. EACH FEE
Fixtures............ Receptacles............ Gas Sytem with up to 5 outlets .............--......... ......... $4.00 .............
TOTAL NUMBER(less than 1000 watts).... ................ $ .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 .............................................I...... ...... 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 ......—................................... .I......... ... 4.50 .............
20/$8.50, 50/$10.00, 100/$12.00, Sop Sink........ Floor Sink........ Floor Drain ....I{1I............ 4,00 ..............
500/$15.00 -............................................. ............. ..............—.............. Urinal.... Interceptor.... Water Softener..:. ..........1............ 4.00 .............
Signs with I XFMR ....................................................... 2.00 .. .....-... Plumbing Piping without fixtures ......................JI............ 4.00
.............
- Each additional XFMR/Time Clock ... ............. ... .50 .. ....._...... Misc. .._........_......-...... .........._.....--........................................................
Annual Electrical Maintenance . .._...__.....25.00 .. .............. Permit Fee .............-....._............ . ...................................$ 6.00
Other (see Ordinance Current) .................. ..................................-.........@, TOTAL PLUMBING PERMIT FEE (plus penalty if app. ❑) S
.............—............................._......—.......................__......-.........-..............
APPLICATION FOR HEATING/COOLING PERMIT
..__......_fy�
Permit Fee .............................................I.......................... $ 6.00T PERMIT INSTALLATION NO. EACH FEE
TOTAL ELECTRICAL PERMIT FEE(plus penalty if app.0l
) $ •-\ Forced Air Unit...........--to loom ................................. $ 6.00 ..............
ON
INSPECTI
• , . ,
�I , w over 1 OOM .................... ........ 10.00 .........-4--
,D Comfort Cooling Unit....to 3 ton/HP............................ 6.00 1.............
Forms / Foundation.........—................... By:.................. Date:.......:........ v to 15 ton/HP........................... 9.50 ............... '
PlumbingGround Work ......................... ........................................-........ U to 30 ton/HP..........................12.00 ...............
oughElectrical ...................................... ...............................-.................. to 50 ton/HP................ ......... . 17.00 ...............
rame - Plumbing and Heating .............................................................. Space Heater........ Wall Heater .......................... ......... - 6.00 ...............
J Insulation / Energy................................................................................... Flues - other than above ...................................-............3.00 ...............
Gas Test ..........-........................-.............................................................. Vent Fan: Kitchen........ Bath ....-...........
....................... ... ...............
Temporary Power Gas / Elect............................................................... Commercial Range Hood 6.00 ...--_-_,,,,,,.
.............................................
Final - Electrical ..................................... ................................................... l Misc. —.......-........-.....................................................................................
Final - Building/ Mechanical .................................................................. Permit Fee .......................................................................$ 6.00
Final - Design Review / Landscaping .................................................... TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. C]) $
Flap — Public Works.............. ......................................
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CITY OF CUPERTINO
10300 Torre Avenue Telephone 252-4505
INSPECTION NOTICE
BUILDING DIVISION
JOB DATE
DRESS v TIME jam`
�IIWYREPDRTO CORRECTION TICE ❑ VIOLATION❑ f
TYPE P.: B DG. ❑ ELE ❑ PLBG.0 MEC . C1
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WEATHER INSP.