03060195 (4) t
RY OF CUPERTINO 0
CITY OF PERMIT APPLICATION FORM
CUPERTINO
4VPN#. Date:
7 3 p, O S 6 3v-v3
Building Address:
Svo 7-1�726?E 441UF
Owner's Name: Phe#:
/ice ifn
PA T L�si t/ 40$1 Z :5.2- 2r1666
Contractor: License #:
67cd 7z-333 /
Contact: Cupertino Business License#:
� Z 3 04 /
' din Permit Info:
Bld Ele t Plumb EDMech El
Job scription:
Idential [ �/sfg-sem 7G°7r� Commercial ❑
Sq.Ft. Floor Area- $/Sq.Ft.:
Cost of Project: Occupancy Group:
1 . /_6 , OF-3
Type of Constructio .
uanti Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERl Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Ener Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
1 of 3
��(C..-- C�'Y OF CUPERTINO C
i'�
CUP TYOF O PERMIT APPLICATION FORM
PN# J Date: -?
Building Address: Mailing Address if different from building address):
75-Yo TiP T c�iTi ✓c� 0(� f tOi
Owner's Name/:J Phone#:
/fG 8C
Contractor: License#:
Ec-'C NtG/e-C efl-,c 5 72-33 3 /
ct: Phon �/-�J ?3/- Mcf Cupertino Business License#:
ContM
lam / Fax:(40-) 74-3856
Building Permit Info:
Bldge D Elect Plumb ❑ Mech ❑
'Job escription: ^
Residential ❑ Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.: _
Cost of Project: Occupancy Group:
Type of Construction: Please check this box r oject is a
second-story addition: ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1 M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax-Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1 OOOA ELECTRICAL
BELEC1001 Elec 600V> I OOOA ELECTRICAL
BELEC200 Elec Svcs 600V<= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA I Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
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