1320 (2) � I F y
PERMIT NUMBO
FOR APPLICANT TO FILL IN
STREET ADDRESS OF PROJECT:
DEPARTMENT
L
Plans Received By....................................................Date ......................... Legal Description: Tr ao1 ocf�........... L terry... L
REO.: Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach..... Description of Work: K e � JA� ! CF�
Plans Checked By...................:..... .. Date .... ... ......... ... list Struct. Improvem�q,t Parcel: es.... Nopf AAIB of Bldg.......7�.
Application Approved By.......... L........._._....Date ..el,r1.7/rick Separate Structure..R... or Addition/Alta ion to Exisy�Bldg.,/r.a..
Validated By..............................................................Date ......................... No. of Stories....2......... Use of uIdin, 701'40Q e.../7rJrA.........
Compensation Certificate Verified By............ Date`......................... Valuation Pr 'act: ,f, �.� ................EMN, M
•• e $ /99 7, 0 e Owner:. lQQT, .Lf...1.CfjtrpYy��','j`/�... •.................. Phone:....................
Contractory( . ..(!F/! -F..._ (�PRIfY Bus.Lice,r.........................
Permit Fee (plus penalty if applicable) ........................$.. .Or.D. �/3 2
Address: ecce .4n_ oSa... 3. .. PhBI1eS7a2-f.�.jq
Plan Check Fee (less deposit of$.......... Rct. #......ecce)$...................... �•, 3 d�A'Jiadiy'B i✓/... D..•,.....,,..,
Energy Plan Check Fee (Dep. of p )$................ecce .
Contractor - Electrical: ........... .....................................
T G,. `F,�^_.Tr u- City Business License N.................... Phone:....................
Strong Motion Fee ..................................................... $..........<..5.... Plumbing:
Plumbing Permit Fee ..........................e5 prnI $- ............... City Business License #...................: Phone:....................
Electrical Permit Fee .................... G..7.T�ct4t...$_ *� ............... Heatingand Cooling ..........................:......
Mach. Ht /Cool Permit $ ....R.. .$...I................... 9 ..........0.....................
0• 8• •••••••••••••• City Business License a.................... Phone:....................
Construction Tax...................... $ - Architect/Designer: Phone:....................
Wat r C n.. .a ecce.$....................... Phone:..................
Sewer Conn. Fee .............. a �l Engineer: .................:............e......................................- U k
Landscape Fee .................... Street Tree as ............$...... ...`..OU Lender: ....................... ... n sown
Misc. Fee .................................................................:......$..... ...........ecce "1 certify that in the pedormance,of the work for which this permit is
e
S-TJ Issued I shall not employ any Person In any manner Be as to become subject
to the workman's compensation!ewe of California."
Type'Const......... Group........ Div......... Dec. Load........ No. Exits........ SIGNATURE OF
Floor Loads: tat.... 2nd.... Other.... Sprinklered.... Area Sep. Walls.... APPLICANT/OWNER ....................................................................DATE ............................
,• ..
• s i certify that as the applicant I em that my
iceer the . roD.fonqq of the
Contractors Licenns'"Law as . r that In Cleanse No. effect.!.............
............ QgJ�
Environmental Status: Exempt........ecce Other.......................................
in Clesslfleauon .3.l..QS..kt. l..a..-----la In full foxes end asset:or
Design Review Approval: Bldg. -""""" ........... """"""
Site . Sign . I certify that I am exempt from the."Licensed Req.'•ad" provisions of the
Contractors License Law. (State basin of exemption.,
Use Zone ............ P.D. Conditions ............................................................ I hereby acknowledge that I have read this'application and state that the above Is
Cond. Use Permit a,,,,,, Variance e...... Parking Spaces.... Load.Sp..... correct and agree to comply with all Clty'Ordinances and State Laws regulating
rovedBy........................................................... Date ........................... building.
I (We) agree to save, Indemnify and keep harmless the City of Cupertino
e• s against Ilablilliee, judgments, Date and expanses which may in any way
46 occurs against said Clly In c sequence of ranting of this permit.
rOachment Permit........................ Grant of Easement........................ SIGNATURE OF
P-17-06
b, Gutter, Sidewalk,.Driveway: Replace Repair APPLICANT/CONTRACTOR .. ecce TE ..Q..v.:. ..
Sewer............ Conn. Fee $................ Water................ Meter $................ NOTE: When properly vmieeted form comdlutes ■.Building P"IL This
Agreement for Completion of Public Works Improvements .................. permit expires and becomes muff amid should work net be commenced within
Plans Checked By........ Date........ Approved By........ Date.................... 120 days from validation dab, or should authorized construction be suspended or
abandoned for s period of 120 days after work Is commenced.
APPLICATION • • ELECTRICAL PERMIT
APPLICATION e• PLUMBING PERMIT
PERMIT INSTALLATION NO. EACH FEE
Light Outlets.........:.. Switches............ PERMIT INSTALLATION NO. EACH FEE
Fixtures............ Receptacles............ Gas Sytem with up to 5 outlets ....................................$4.00 ...........••
TOTALNUMBER(lessthan 1000watts).....................$ .56 .-- - 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 Healer.... Lit. 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 .............
900/$20.00, 1200/$40.00 ................................. ............................... Sewer ........1 9.00. .............
.....................................................................
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 Softener.... ..........�_._......... 4.00 .............
Signs with I XFMR ......................................ecce............. 2.00 ................ Plumbing Piping without fixtures .................................. 4.00 .............
Eachadditional XFMR/Time Clock .. ............. ... .50 .. .............. Misc. ........................................---............................ ..................................
Annual Electrical Maintenance .................25.00 ................ Permit Fee ..........................................................................IS 6.00
Other (see ordinance Current) ..................-............................ .............. TOTAL PLUMBING PERMIT FEE (plus penalty if app. E]) 111
........................................... .............. APPLICATIONs• ee
.....:.................................................................... ................................
Permit Fee ........................................................................ $ 6.00 PERMIT INSTALLATION NO. EACH FEE
TOTAL ELECTRICAL PERMIT FEE(plus penalty if app.❑) $ Forced Air Unit...............to 100M ................................. $ 6.00 ...............
over 100M .................... ........ 10.00 ..............
Comfort Cooling Unit.....to 3 ton/HP............................ 6.00 ...............
Forms / Foundation............................... By:.................. Date:................ to 15 ton/HP........................... 9.50 ...............
mbing Ground Work ........................................................................... to 30 ton/HP..........................12.00 ...............
ghElectrical ........................................................................................ to 50 ton/HP.......................... 17.00 ...............
me - Plumbing a d ea'n .. ecce a Space Heater........ Well Heater ......................................6.00 ...............
�• / .. �wf P Flues - other than above ................................................3.00 ...............
Teat .................................................................................................... Vent Fan: Kitchen........ Bath .............................-............3.00 ...............
Temporary Power Gas / E)ect............. Commercial Range Hood ..8.00 ,.......,.,,--.
Final - Electrical ........................................................................................ Misc. ...........:...............................................................................................
-anal - Building/Mechanical .................................................................. Permit Fee ........................................................................$ 6.00
•al - Design Review / Landscaping .................................................... TOTAL Htg./ Coolg. Permit Fee (plug penalty it app. ❑) $
l ' - Public Works...........................................................