The URL can be used to link to this page

1420 (2) PERMIT NUMBER FOR APPLICANT TO FILL IN STREET ADDRESS OF PROJECT: U.0144 4t ................................ .5.......S-17 DA E ............. . Plans Received By....................................................Date ......................... Legal Description: Trac Block Lot REQ.: Plans.... Survey.... Celts: Strut..... E Description o , ..l. ........ Energy.... Elect..... Mach..... S 1A.) M, Plans Checked By.................. .. .. 0.*, ; p: let Struct. Improvement on Parcel:Yes.... No.... Arga of Bldg............... .�' .,el....... Date/ ;�. . Application Approved-B.-y... -4q Date .... eo Separate Structure............ or Addition/Alteration to Exist. Bldg........... Validated By..............................................................Date ........................ No. of Stories................ Lille of BuildiQg ................................................ Compensation Certificate Verified By.................... Date ........................ Valuatiov of Project: $ Cd ........................... $ Owner: 4NI.0 DiZf Contractor: ll.Krcm ;;,._0OL6 C Bus. ic # Permit Fee (plus penalty it applicable) .... $... P W%.41.0"NO...._ 4,....... one. ........ Plan Check Fee (less deposit of $.......... R contractor - Electrical: .-............................................................................ Energy Plan Check Fee (Dep. of $........ Rct. #........) $......... ....... CtyBriness License #................... Phone:.................... I RCrl.M.G ..................................... Strong Motion Fee ................................................................................ Plumbing Permit Fee .............................. ................. T 3 Plumbing:City Business Licens ................... Phone:.................... ............................ Heating - Cooling ....=_ .K1;r Electrical Permit Fee .......................... A I. ......ik .;;)0JLA&................. Mach. Htg./Coog. Permit $ ..............................$....................... C1� B mass L' e nse #........M.............. Phone:........... Construction Tax.............................................$....................... Architect/Designer 5.k kZ&.qAI4 Prone:S.U . .5i Sewer Conn. Fee .............. Water Conn. Fee ..............$....................... Engineer: ...................................................................... Phone: Wit.ow.n. ................. Landscape Fee ................:... Street Tree Fee ............$............ Lender: ............................... _............ ...............................tx.U6 Misc. Fee ........................................................................$.................. ........ "I certify that In the performance of the work for which this permit Is [ON Intel 2:1 N fflgn�, $ issued I shall not employ any portion in any manner so as to become subject to the workman's compensation laws of Callfqrnla." Type Const......... Group........ Div.... .. Dec. Load........ No. Exits........ SIGNATURE OF Floor.Loads: 1st.... 2nd.... Other.... Sprinklered.... Area Sep. Walls.... APPLICANT/OWNER AMIL.......DATE that ZONING REQUIREMENTS ....... I cantly faq a applicant I arri licensed under the provislonsAf the Contractors L' nu Life, and further that my License No. Environmental Status: Exempt............ Other........................................ In Classification .......L;.!7n,!973.............. Is In full force and effect: or Design Review Approval: Bldg. ............ Site ............ Sign ............ ............ I certify that I am exempt from the "Licensed Req.',ed" pron,litions of the Contractors License Law. (State baste 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 e......Variance e...... Parking Spaces.... Load.SIP..... correct and agree to comply with all City Ordinances and State Lam regulating rovedBy........................................................... Date ........................... building. I (we) agree to save, indemnify and keep harmless the City of Cupertino agairst liabilities, judgments,costs and expenses which may In any way occurs against said City In consequence of the granting of this permit. �Qpoachmernt Permit........................ Grant of Easement........................ SIGNATURE OF I PermitDATE Gutter, Sidewalk, Driveway: Replace Repair APPLICANT/CONTRALTO APPLICANT/Cl �. .AAA....1 A.A this Sewer............ Conn. Fee $................ Water................ Meter $................ NOTE: When Property V this form constitution; a Building Permit. This Agreement for Completion of Public Works Improvements .................. permit expires and becomm null and sold should work not be commenced taliddr, Plans Checked By........ Date........ Approved By........ Date.................... 120 days from validation dab,or should autharbard construction be suspended ce N FELECTRICAL PERMIT abandoned for a period of 120 days after work Is commenced.. APPLICATIOOR selales"as APPLICATION FOR PLUMBING PERMIT PERMIT, INSTALLATION NO. EACH FEE Light Outlets....4.-... Switches............ PERMIT INSTALLATION NO. EACH FEE Fixtures....9... Receptacles............ Gas Sytern with up to 5 outlets ............................f... $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.... Lill. Tray.................... 4.00 ............. SERVICE OR TEMPORARY POWER to . ................. 2.00 ............... Lavatory.... Shower Pan.... Bathtub.... Sink.................. 3.00 ............. too 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, eater Lawn Sprinkler Sys. $6.00 Ea. add sys. $2.0 ...).... ............ ............. per HP-KW-KVA to 1/$2.00, 5/$3.50, Vacuum Breakers ............................................ . .. .... .. 4.50 ...Y."J..o 20/$6.50, 0/$10.0 100/$12.00,100/$12.00, Slop Sink........ Floor Sink........ Floor Drain ............. 4.00 ............. 500/$15.00 ...................................................... ......................../10,070 Urinal.... Interceptor....Water Softene' 4.00 . ............. Signs with I XFMR ...................................... 2 Plumbing Piping without fixtures&...... 4:00 - - Each additional XFMR/Time Clock Misc. Pt.4�70A.... J/ ....................I. .... Annual Electrical Maintenance 25.00 .. .............. Permit Fee .........................................................................$ 6 00 Other (see Ordinance Current) .................. ................ ............ J TOTAL PLUMBING PERMIT FEE (plus penalty If app. 0) IV�0_0 ......................................................................... ................ ............. APPLICATION FOR HEATING/COOLING PERMIT A, . I.. I .......................................................................... ...... ...... ........... Permit Fee ........................................................................ $ 6.00 PERMIT INSTALLATION IMAM FEE TOTAL ELECTRICAL PERMIT FEE(plus penalty if app.0) $ jig6t.() Forced Air Unit...............to 1DOM .. ............... ......... $ 6.00 ............... INSPECTION RECORD over LOOM ...................... ........ 10.00 ............... Comfort Cooling Unit.....to 3 ton/HP............................ 6.00 ............... Forme / Foundation............................... By:.................. Date:................ to 15 ton/HP............................ 9.50 ............... mbln Ground Work ......................... .................................................. to 30 ton/HP................ .......... 12.00 ............... og g I ........ 17 Go If'Electrical ............................. ................................................... to 50 ton/HP... ................. ' a - Plumbing and Heating ........... ....................................:.............. Space Heater........ Wall Heater ..........................7_6*oo ............... .....*........ .. lotion /Energy........................................................ ........................... Flues - other than above ....................... ...3, OD ............................ Test ................................................. ................................................... Vent Fan: Kitchen........ Bath ..............*................. I' 3.00 ............... Temporary Power Gas / Elect.............................................................. Commercial Range Hod ................................. ............... 6.00 .............. Final - Electrical ..................................... ................................................... Misc. .................................eL................ ....................................................... Le Final - Building/Mechanical ............... ................................................... Permit Fee ........................................................................$ 6.00 Final- Design Review Landscaping I........................I........................... TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. 0) $ Final - Public Works ............................. ....... I I Pf t K d2oS-r Ar, 6 ,. -11G. zr-c . 01-e CXV -Ca