10100002CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 20061 SUISUN DR C014TRACTOR: AAA FURNACE & AIRI PERMIT NO: 10100002i I I
CONDITIONING
OWNER'S NAME: KOOROSH ALFATOONI
WNER'S PHONE: 4083430640
❑ LICENSED CONTRACTOR'S DECLARATION
License Class^� ,„3 C'ZG Li.. # `7 4!0 8-8 -71
ContractorA" K-1 rya Qs_ Date V -10
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenJsourc
ay accrue against said City in consequence of the
granting of this itionally, the applicant understands and will comply
with all non-poiulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
iloon the above mentioned property for inspection purposes. (We) agree to save
:mnify and keep harmless the City of Cupertino against liabilities, judgments,
sts, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date,
171:: STONE AVE
SAP I JOSE, CA 95125
DATE ISSUED: 10/01/2010
PHONE NO: (408)293-4717
JOII DESCRIPTION: RESIDENTIAL U COMMERCIAL
REPPLACE FURNACE AND CONDENSER 220
ELECTRICAL
Sq. Ft Floor Area:
APN Number: 36928004.00
Valuation: $8187
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by, �,��iT� Date:
RE -ROOFS:
Al roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
ins pection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I Have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
in aintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
H !alth & Safety Code, Section 25532(x) shou d I store or handle hazardous
material. Additionally, should I use equip e t or devices which emit hazardous
ai r contaminants as defined by the B ea it Quality Management District I
w 11 maintain compliance with the up Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sec n 25 , 25533, and 25534.
Owner or authorized agent: Date: &
CONSTRUCTION LENDING AGENCY
I iereby affirm that there is a construction lending agency for the performance of
H ork's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CITY OF
#UPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
('o 'I�U ;sur, ,2 .
PERMIT #
e16604v
OWNER'S NAME: )2 -' 66,^j;
PHO # S- - - 6v
GENERAL CONTRACTOR: gq y& p
FAX #4 65Z- - 7.7
I am not using any subcontractors:
Signa--ure Date
Please check avvhcable subcontractors and com lets! the following information:
Owner/ Contract ignature
Date
60
SUBCONTRACTOR
BUSINEr-S NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Met
Sheet R9&/
T' ier-
�IZ
Owner/ Contract ignature
Date
6 ITEMS OF 29
CITY OF CU:?ERTINO
PERMIT R:3CEIPT
Sec: Twp: Rng: Sub: Blk: mot:
APN ........: 36928)04.00
DATE ISSUED.......: 10/01/2010
RECEIPT #......... BS000)11611
REFERENCE ID # ...: 1010002
SITE ADDRESS .....: 20061 SUISUN DR
SUBDIVISION ......
CITY CUPERTINO
IMPACT AREA ......
OWNER KOOROSH ALFATOONI
ADDRESS 20061 SUISUN DR
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
OPERATOR: SylviaM
COPY # : 1
RECEIVED FROM ....: AAA FURNACE
CONTRACTOR RANDC, JIM LIC # 8050
COMPANY AAA FURNACE & AIR CONDITIONING
ADDRESS 1712 STONE AVE
CITY/STATE/ZIP ...: SAN JOSE, CA 95125
TELEPHONE ........: (408)293-4717
FEE ID
UNIT
QUANTITY
AMCUNT
PD -TO -DT
THIS REC
--------------------
NEW BAL
----------
1BCBSC
-------------
VALUATION
----------
8,187.00
----------
1.00
----------
0.00
1.00
0.00
1BSEISMICR
VALUATION
8,187.00
0.90
0.00
0.90
0.00
1MFR=<100
UNITS
1.00
126.00
0.00
126.00
0.00
1MPERMITFE
FLAT RATE
1.00
42.00
0.00
42.00
0.00
1MRRAA
UNITS
1.00
63.00
0.00
63.00
0.00
1TRAVDOC
FLAT RATE
1.00
42.00
0.00
----------
42.00
----------
0.00
----------
TOTAL PERMIT
----------
274.90
0.00
274.90
0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
AMOUNT
---------------
1,311.10
---------------
1,311.10
VOICE ID DESCRIPTION
-------- ----------------------------
505 FINAL ELECTRICAL
508 FINAL MECHANICAL
REFERENCE NUMBER
--------------------
:7223
VOICE ID DESCRIPTION
-------- ----------------------------
507 FINAL PLUMBING
CITY OF CU'ERTINO
r ctimTw ,r ♦ mnTl D7 -"7T T7N!'_' 1i1vTI QTin1v
APPLIANCE / EQUIP TYPE
rr.r. r.oi i1.ini..�.--
u, --
QTY/FEE
QTY
ADDRESS: DATE:
REVIEWED BY:
A/C Units (<=10K cfm)
"VALUATION: $8,187
APN: BP#:
#
*PERMIT TYPE: Mechanical Permit
PLAN CI[ECK TYPE: Alteration / Addition / Repair
PRIMARY 7011/ PENTAMATION FURN/AC
SFD or Duplex 1 , �{ ,,� €;; � PERMIT TYPE: Al
USE:
1
WORK
$126
SCOPE
PME Unit Fee:
APPLIANCE / EQUIP TYPE
FEE ID
u, --
QTY/FEE
QTY
UNITS
BP FEES
A/C Units (<=10K cfm)
1BREMAIR
1
#
$63
Furnace, Forced -Air
1MFR=<10o
sdlppi, h; "�/" 1 ev
1
#
$126
TOTALS: I I I I $189.001 1
-- 1-. _ ..s:... s,. !'...,innf iho Dom far addn'I Znfa.
NOTE: These fees are based on the pretinunary in orrnuuvn
FEE ITEMS (Fee Resolution 09-051 E('. 7%lil0j
Mech. Plan Check 0.0 1 hrs $0.00
u, --
QTY/FEE
MISC ITEMS
Fmech. Permit Fee: IMPERMIT
Other Mech. Insp. 0.0 hrs
PME Plan Check:
$0.0C
-- 1-. _ ..s:... s,. !'...,innf iho Dom far addn'I Znfa.
NOTE: These fees are based on the pretinunary in orrnuuvn
FEE ITEMS (Fee Resolution 09-051 E('. 7%lil0j
uvuu suit
FEE
u, --
QTY/FEE
MISC ITEMS
sirpp/. 1 J{" I' cc
PME Plan Check:
$0.0C
Pet-�nld I-'t�e"
sdlppi, h; "�/" 1 ev
PME Unit Fee:
$189.0(
PME Permit Fee:
$42.0(
Con.wrlicig"o 'i
1�
Work Without Permit? 0 Yes E) No
$0.00
i
Travel Documentation Fee: ITRA VDOC
$42.00
Strong, Motion Fee:
$0.82
Select an Administrative Item
BldyStds Commission Fee: IBCBSC
$1.0)
SUBTOTALS:
$274.82
$0.00 TOTAL FEE: $274.82
• nnwn
VV Iov - N/ LTJ/ LV . v
1. Use Low/No-VOC Paint
1 IAQ/Health pts
y=yes
2. Use Low VOC, Water -Based Wood Finishes
2 IAQ/Health pts
y=yes
3. Use Low/No VOC Adhesives
3 IAQ/Health pts
y=yes
4. Use Salvaged Materials for Interior Finishes
3 Resource pts
y=yes
5. Use Engineered Sheet Goods with no added Urea
4 Resource pts
y=yes
Formaldehyde
61AQ/Health pts
y=yes
6. Use Exterior Grade Plywood for Interior Uses
1 IAQ/Health pts
y=yes
7. Seal all Exposed Particleboard or MDF
4 IAQ/Health pts
y=yes
B. Use FSC Certified Materials for Interior Finish
4 Resource pts
y=yes
9. Use Finger -Jointed or Recycled -Content Trim
1 Resource pts
y=yes
10. Install Whole House Vacuum System
3 IAQ/Health pts
y=yes
N. Flooring
1. Select FSC Certified Wood Flooring
3 Resource pts
y=yes
2. Use Rapidly Renewable Flooring Materials
4 Resource pts
y=yes
3. Use Recycled Content Ceramic Tiles
4 Resource pts
y=yes
4. Install Natural Linoleum in Place of Vinyl
5 IAQ/Health pts
y=yes
5. Use Exposed Concrete as Finished Floor
4 Resource pts
y=yes
6. Install Recycled Content Carpet with Low VOCs
4 Resource pts
y=yes
Total oints Availablel
Total Points Project Received:
G:datWprogs
M
X
I -f AM ,r3n I57
CITY OF CUPERTINO
FURNACE/AC ^..
CUPEkTINO PERMIT APPLICATION FORM
1
IN��
APN # 0oq ;-y Date: I /t
Building Address:
'POOL I S tA hStar\ l"v£
Owner's Name:
XQa Q ti-, A 1` LCA+cX,--! t
Phone #:
Z}1)8 - 3-9 3 - o(o y C)
Contractor: Ran (3D
_
Phone #: 4-o�-_ X93 _ 4()/'
Fax #:4 -OS -ag3 _ & "77 /
_
Contractor License #: �o
Cupertino Business License #:
8U5v
Contact: C-7a12Y �t � ,-- / �� C -1 {/
/
Phone #: � X9,3--�/ 7/ 7
--
Fax #: 409 - 9 3 ' 7 `t f
building Permit Into:
Elect
Residential
Job Description: '�em0ve
Ctd 4 Ocyaen-ser 4 -
Plumb
For Residential Installations:
Attic ❑
PttrV0CC
Mech
Commercial
7-2
Adhere to minimum setback rec
1" floor i:3—
irement
2"d floor ❑
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) []
Structural Calculations required for new installation ❑
New installation Planning Approval Reouired F -
Cost of Project: Type of -onstruction sage Class):
Strapped ❑ On Platform ff
Project Size: Express ❑ Standard
Valuation:
Bon Jed New Location Replacement
❑ Major ❑
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, include in plan set & the sheet index.
Reviled 01/07/09
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20211 SUISUN DR CONT 2ACTOR:
OWNER'S NAME: JUMANA & ZOAIB RANGWALAL % cx_�)
PERMIT NO: 10100104
DATE ISSUED: 10/14/2010
T_R'S PHONE: 4088281438 I of 6—re 2 Q -TI 00 _," L1 I PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. # G 2.5
Contractor&��pi��GDate 10— t Lt —k-0
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. n
APPLICANT CERTIFICATION 4 ' tt .
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source re ations per the Cupertino Municipal Code, Section
9.18. � /
Signature _ Date ` l "t _(0
O
L OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
it ' -nify and keep harmless the City of Cupertino against liabilities, judgments,
C nd expenses which may accrue against said City in consequence of the
grunting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
BUILDING PERMIT INFO: BLDG F ELECT F PLUMB r
MECH F RESIDENTIAL F COMMERCIAL r—
JOB I DESCRIPTION: INSTALL NEW FIBER CEMENT SIDING OVER EXISTING
WOOD
Sq. Ft boor Area:
APN N amber: 36928015.00
Valuation: $6000
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
1H DAYS FROM LAST CALLED INSPECTION.
Issued by: Date:—j
RE -ROOFS:
All roof s shall be inspected prior to any roofing material being installed. If a roof is
installeA I without first obtaining an inspection, I agree to remove all new materials for
inspecti in.
Signatu -e of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
Califor aia Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compli:Lnce with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additic nally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
mainta n compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Saf Zons 25505, 25533, and 25534.
Ow r r
Dater
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for whi(.h this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I under, tand my plans shall be used as public records.
ISignature Date I Licensed Professional
CITY OF CUPFRTINO
4 ITEMS OF 4 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36928015.00
DATE ISSUED.......: 10/14/,'010
RECEIPT #.........: BS000011744
REFERENCE ID # ••.: 10100104
SITE ADDRESS .....: 20211 f;UISUN DR
SUBDIVISION ......
CITY .............. CUPERTINO
IMPACT AREA ......
OPERATOR: patg
COPY # : 1
OWNER ............: JUMANA & ZOAIB RANGWALA
ADDRESS ..........: 20211 c:UISAN RD
CITY/STATE/ZIP ...: CUPERTINO, CA 95014-4427
RECEIVED FROM ....: ALEKSEY MORONCHIK
CONTRACTOR .......: TBD - TO BE DETERMINED LIC # 00096
COMPANY ..........: TBD - TO BE DETERMINED
ADDRESS ..........
CITY/STATE/ZIP ...: ,
TELEPHONE ........
FEE ID UNIT
QUANTITY
AMOUrfT PD -TO -DT
THIS REC
NEW BAL
-----------------------
1BCBSC VALUATION
----------
6,000.00
--------------------
1.00
0.00
----------
1.00
----------
0.00
1BSEISMICR VALUATION
6,000.00
0.60
0.00
0.60
0.00
1BUSLIC FLAT RATE
1.00
114.00
0.00
114.00
0.00
1SIDEOTHER SQ FEET
500.00
5"0.00
0.00
570.00
0.00
TOTAL PERMIT
---------- ----------
6£5.60
0.00
----------
685.60
----------
0.00
METHOD OF PAYMENT
AMOUNT
F'EFERENCE
NUMBER
----------------- ---------------
CREDIT CARD
685.60
--------------------
VIE;A
---------------
TOTAL RECEIPT
685.60
Building Department
City Of Cupertino
10300 Torre Avenue
191 Cupertino, CA 95014-3255
Telephone: 408-777-3228
C O P E RT I N O Fax: 408-777-3333
CONTRACTOR / SUB(±ONTRACTOR LIST ,
JOB ADDRESS: 70 2 j( G LA -i 5,:, t,, NIZ
PERMIT #
OWNER'S NAME: 7oki rz
PHONE # - 30<2 - 3 pC)
GENERAL CONTRACTOR: {Qtz Co :t A
USINESS LICENSE #
ADDRESS: ,��Q S �CLfF� L S,tk-_ cam (*--? ?If
CITY/ZIPCODE:
-`Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONT CORS AVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
7gnatiire Date
Please check applicable subcontractors and complete the following information:
Owner / Contractor Signature
Date
SUBCONTRACTOR
BUSINESS 1` AME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature
Date
,�. CITY OF CUP]ERTINO
FFF FCTIMATOR - BUILDING DIVISION
AInTG'. Tb.,c., f .,c "r A"cod nn rho nrofiminary infnrmatinn availahl o and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 09-051 Ef'. '%li/0j
ADDRESS:
DA rE:
REVIEWED BY:
tf'�"ref. h 1YNl1 f �C'L'.
APN:
BP#:
*VALUATION: 1$6,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
USE: SFD or Duplex
f { 7 [ , '
r �;�rt,° ,,,; ;�
PENTAMATION 1 GENRES
PERMIT TYPE:
WORK
SCOPE
AInTG'. Tb.,c., f .,c "r A"cod nn rho nrofiminary infnrmatinn availahl o and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 09-051 Ef'. '%li/0j
FEE
11TY/FEE
MISC ITEMS
tf'�"ref. h 1YNl1 f �C'L'.
� It."?,. ' <tf7� r: c•t,.
7>.rc ('. ��ci'177(! %`-;,'er'
500 s.f.
$570.00
Siding
ISIDEOTHER All Other
Cit ,, f 1, k7 ( lush.
1t'� fr tf 4 1
P..rn 3 1.: ! :
1"_Wc. Ius>f Fci
AInTG'. Tb.,c., f .,c "r A"cod nn rho nrofiminary infnrmatinn availahl o and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 09-051 Ef'. '%li/0j
FEE
11TY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
500 s.f.
$570.00
Siding
ISIDEOTHER All Other
Suppl. PC Fee: E) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
(-Uit. ff'Ir`t FT017 711",
Acoustical Fee: 0 Yes (F) No
$0.00
0
Work Without Permit? 0 Yes E) No
$0.00
Plannin�
$0.00
Select a Non -Residential E)
Building or Structure
7 p
'TTj-({�>c l.)C)C1t177£'p7 iCdf'(1J7 Fcf,.1.'
Strong; Motion Fee: IBSEISMICR
$0.60
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$1.60
$570.00
TOTAL FEE.
$571.60
Revised: 9/29/2010
CHE''GEi ;a : By
i
I
OF CU
CITY PERTINO : 4
CITY OF _... .
Cu FEKTI NO GENERAL BUILDING } .
PERNUT APPLICATION FORS
zvoo/o/
AP T#, CJ`" ,l'
- i