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1844 (2) Ty OE CUpERTINO P b . a u _1 A 1 . P I .IAN PERMIT NUMBER lk�6 FOR APPLICANT TO FILL IN LIL STgEET ADDRE! �F PROJECT: r . ;j /34 OS/O J%Bv�v I (,C7 !'Z /3L✓ O, Cup.2htino....0 0.h4.4.2k ads............................................. Plans Received By....................................................Date ......................... Legal Description: Tract................... . BIQck............ Lot...................... REQ.: Plans.... Survey.... Celcs: Struc..... Energy.... Elect..... Mach..... Description of Work: Ino.x1L.e.e.....(.2.).....4..L.9.n4......................... Plans Checked By........... . . ...... Date .............. . list Struct. Improvement on Parcel:Yes.... No....Area of Bldg............... Application Approved By... . .. .... . ...... ....... Date �.1. L.S..�..9 0 Separate Structure............ or Addition/Alteration to Exist. Bldg........... ..... .... . ValidatedBy..............................................................Date ......................... No. of Stories................ Use of Building .................................................. Compensation Certificate Verified By.................... Date ......................... Valuatiopp ofppro'e t: $... 45.0...Q.Q ................................................. • . . . • Owner: tf....U.R. o.n..: .q.o.1�4.2,d.. .ln1L.......... Phan 0- .. 04 contractor, . . Y & - Permit Fee (plus penalty If applicable) ........................$....7................ 0.... ti n4.. Crit Bus.Lic.. Ph�.e:-.% (P P ty PP Address: .2.2.6.�....�... M.. R A 7 - Plan Check Fee (less deposit of$.......... Rct. #..........)$....................... - .. ..'C . 2........V.lw.............. Phone:........�......... 3 Energy Plan Check Fee (Dep. of $....:... Rct. #........) $............. . Contractor - Electrical:Business .................................................... :.................... Strong Motion Fee ..........................................................$.........L.�/.. .. City Business License e.................... Phone:.................... Plumbing: ............................................................................... Plumbing Permit Fee ................................................$. ...... ...............- City Business License w.................... Phone: .................... Electrical Permit Fee ......................................................$/.9..... ..... Heatingand Coolies Mach. Ht /Cool Permit $ ..............................$....................... g ........................................... :.................... 0• 0• City Business License �.................... Phone:.................... Construction Tax.............................................$....................... Architect/Designer: Phone:.................... Sewer Conn. Fee ............:. Water Conn. Fee ..............$....................... Engineer: .. -• Phone.................. Landscape Fee .................... Street Tree Fee ............$....................... Lender: ....................................................................................2....Unknown Misc. Fee ...............................................................:........$....................... ...... •-I certify that In the performance of the work for which this permit Is ...... • • . . ; $/ 7 .S� Issued I shell not mploy any n laws In any manner so es to become suD)sat to the workma c mpensatlon laws ell " Type Const......... Group........ Div.... Occ. Load........ No. Exits........ SIGNATURE of - Floor Loads: list.... 2nd.... Other.... Sprinklered.... Area Sep. Walls.... APPLICANT/OWNE . ..... . . ....... ... ...:. ..... .. DATEI..J../.J..Z./..k.0 • • ............ I tartly that as In spplic am licensed under the pro�Isjo s of l Contractors License rther that m Lltenes No. ...(.y�..Q.].. ... 44 y Environmental Status: Exempt............ Other............... in Classification ...... .... ....................... is In full force and effect: or ""'""""""""" certify that I ern exempt from the "Licensed Req.'rod" provisions of the Design Review Approval: Bldg. ............ Site ............ Sign ............ Contractors License Lew. (State bests of exemption., Use Zone ............ P.D. Conditions .......................................................... I hereby acknowledge that I have reed this application and state that the above Is Cond. Use Permit e...... Variance M...... Parking Spaces.... Load.Sp..... correct and agree to comply with all Cly Ordinances and State Lawn regulating toachmall ed By........................................................... Date ........................... building. I (we) agree to save, indemnity and keep harmless the City of Cupertino against liabilities, ludgm casts antl exp a hick mayin any way acture against saitlCit in n e :ante h ra I of mis permit. rmit........................ Grant of Easement........................ SIGNATURE OF Guttewalk,.Driveway: Replace Repair APPLICANT/CONTRALTO .... .. .. ... TE�..�..�..]..�. .g.O Sewer............ Conn. Fee $................ Water................ Meter $................ NOTE: when property vatidebd Ina coes9luIn a Building Permit This. Agreement for Completion of Public Works Improvements .................. permit expires and becomes null and hould work net be commenced teiUdn Plans Checked By........ Date........ Approved By........ Date.................... 120 day ham validation date, or shoo Ihorwd convection be suspended or abandoned for a period of 120 dM aha work Is commenced. APPLICATION •• PLUMBING PERMIT INSTALLATION NO. EACH FEE Light Outlets............ Switches............ PERMIT INSTALLATION NO.I EACH FEE Fixtures............ Receptacles............ Gas Sytem with up to 5 outlets................................... $4.00 .........•••• TOTALNUMBER(lessthan 1000watts).....................$ .5o .............. 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/$8.60, 50/$10.00, 100/$12.00, Slop Sink........ Floor Sink........ Floor Drain ................ 4.00 ............. 500/$15.00 .............................................. ............. ...................... . Urinal.... Interceptor.... Water Softener.... ...................... 4.00 ............. Signs with I XFMR ...................................... ..�........... 2.00 ..-. 'L_ Plumbing Piping without fixtures .................................. 4.00 ............. Each additional XFMR/Time Clock .. ................ .50 ................ Misc. ........................................................................................................... Annual Electrical Maintenance ................ 25.00 ................ Permit Fee ..........................................................................$ 6.00 Other (see Ordinance Current)................................................. .............. TOTAL PLUMBING PERMIT FEE (plus penalty If app. p) $ ........................... ............ ..........-- APPLICATION FOR ee . .......................................................................... ............. ... ................ Permit Fee .................. .................................................... $ 6.00 PERMIT INSTALLATION NO. EACH FEE TOTAL ELECTRICAL PERMIT FEE(plus penalty if app.p) S Q Forced Air Unit...............to 100M ........................ ......... $ 6.00 .•......••.... • • e • r over 100M .................... ........ 10.00 .............. Comfort Cooling Unit.....to 3 ton/HP............................ 6.00 .............. Forms / Foundation............................... By:.................. Date:................ to 15 ton/HP........................... 9.50 ............... bing Ground Work ............................................................................ to 30 ton/HP..........................12.00 ......9....... InElectrical ........................................................................................ to 50 ton/HP.......................... 17.00 ............... me - Plumbing and Heating .............................................................. Space Heater........ Wali Heater .......................... ..........6.00 ............... anon / Energy................................................................................... Flues - other than above ................................................3.00 ............... Teat .................................................................................................... Vent Fan: Kitchen........ Bath ..........................................3.00 ............... Temporary Power Gas / Elect............. Commercial Range Hood 8.00 Final - Electrical ........................................................................................ Misc. ........................................................................................................... Final - Building/Mechanical .................................................................. Permit Fee ..:....................................................................$ 8.00 Final - Design Review / Landscaping .................................................... TOTAL Htg./ Coolg. Permit Fee (plus,penalty if app. p) $ Final - Public Works...........................................................