2107 CITY OF CUPERTINO
APPLICATION FOR COMMERCIAL BUILDING PERMIT PERMIT NUMBER 2107
AND
' ' •' '
• CERTIFICATE OF OCCUPANCY FILL IN
BUILDING INSPECTION DIVISION STREET ADDRESS OF PROJECT:
' Plans Received By....._.....---..................___........Date .......... ....... Legal Description: Tract ..._...
Block............ Lot. ..............
REO.: Plans._. Survey.... Calcs: Struc..... Energy.... Elect...../Meth..... Description of Work: ._.. ...fi.r .C,.._..............._............_...................
Plans Checked By...._.......a.."(m Date ...,.f/. / 1st Struct. Improvement on Parcel: Yes.._ Ne.... Area of Bldg........
Application Approved By.�c!„ ,.1-_.................._... Date Separate Structure__....._. or Addition/Alteration to Exist. Bldg...........
f ....... ...
Validated B --_.....Date ��... ..........._. No. of Stories................ Use of-Building
y.......................,....... q ............................_.........._........
Compensation Certificate Verified By.. -.......-.....Date ......................... Valuation of Project: $
................
•. • . . � $ ✓ Owner: )A!."I r>zGi.S-......I.Al_ ..................... ..... Phone:....................
.� Contractors?i?w-S$..Cc.-:"_L-,e-.4 City Bus.Lic. #......_........................
Permit (Plus penalty if applicable) ........................$_.f�t...Ll..:.a'Ct. Address: ../ .{{e. r�x ,c 35.1..-i-sd
. . ..............:C.r. Phone:... . . .........
Plan Check Fee (less deposit of $....... Rct. #..........)$........_.........._ Contractor - Electrical: ........__......_................
Energy Plan Check Fee (Dep. of $... .... Rct. #........) $.._......"..._/. .. City Business License #:................... Phone:....................
Strong Motion Fee ...._............_........._......____.....__....$......._�.,...._q Plumbing: ....
Plumbing,Permit Fee .........._.......---.... .............._-$.... City Business License 0.................... Phone:....................
t Electrical Permit Fee ......................................................$.......................
Heating and Cooling ................_......_.................._.................
Mach. Htg./Coolg. Permit $ ..............................$-_.............._... City Business License 0.................... Phone:...................
Construction Tax.............................................$............._..._... Architect/Designer: ........................................ ......... Phone:....................
Sewer Conn. Fee .............. Water Conn. Fee ........ ... .$..........._....__.. Engineer: .__....... ........... Phone:.........
_......__....._......................... Unknown
LandscapeFee _....._........... Street Tree Fee _..__....$....... .......... Lander: ..............._............................._........._......_.................�..................
Mise. Fee ._._...._............:..._...................._..._......_...:_.$. .. ....._.....c.•.�r _ "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 ee to become subject
�ILto the workman's compensation laws of California."
Type Const......... Group........ Div......... Occ. Load........ No. Exits........ SIGNATURE OF �j y^j� q f���
Floor Loads: 1st.... 2nd.... Other..., Sprinklered.... Area Sep. Walls._.. APPLICANT/OWNER._._,..._....__..............e:r......-- ..-...... .... DAT. ..........................
ZONING REQUIREMENTS ............ I certify that as the applicant I am licensed under the provisions of the
Contractors License Law and further that my License No. ..__.....................
Environmental Status: Exempt ...... Other.............. in Classification ................._........_.......— Is In full force and enact. or
Design Review Approval: Bldg. ....--- Site ..._...... Sign -- Contserfiractors
that en exempt from the "Licensed Reg, ad"d" proWelone c e
""'"""" Contrecton License Lew. (Stele 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 #...... Variance #...... Parking Spaces.... Load. Sp...". correct and agree to comply with all City Ordinances and State Laws regulating
Approved By._.._....__............................................ Date .. building. ,
I (We) agree to save, indemnity and keep harmless the City of Cupertino
• ' • against liabilities, judgments, costs and expenses which may In any way
acture against said City in consequence of the granting of this permit.
Encroachment Permit........_........____. Grant of Easement.........._......._... SIGNATURE OF ,ter
Curb, Gutter, Sidewalk,. Driveway: Replace Repair [ebwdoned
ICANT/CONTRACTOR.-.::`.-.`_...- :"E�...:r.__ —..,.—DATE`C .'...l.... '
Sewer............ Conn. Fee $................ Water................ Meter $............_... : When properly validated this form comaWtes a Building Parma. This
Agreement for Completion of Public Works Improvements ..._— u expires and become, null and vold shmW work not be con.n.nced within
Plans Checked By..._.. Date......_ Approved By........ Date......_............ . rys from valklaron date, or should authorized combuction be suspended er
for a period of 120 days after work Is commenced.
APPLICATION • • ELECTRICAL PERMIT APPLICATION FOR PLUMBING PERMIT
PERMIT INSTALLATION NO. EACH FEE
Light Outlets............ Switches....._...... PERMIT INSTALLATION NO. EACH FEE
Fixtures............ Receptacles............ Gas Sytem with up to 5 outlets .....................................$4.00
TOTAL NUMBER(less than 1000 watts) ... ...... ....$ .50 --_. Each additional outlet ...:.................._L................. 1.00 ..-..........
Range........ Cooking Unit........ Oven............ ................. 2.00 . ... .... Water System (Installation, Alt. or Repair), ......._.....I . 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. Dlsp..... .._........_. 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/$8.50, 50/$10.00, 100/$12.00, . Slop Sink........ Floor Sink........ Floor Drain .._11I_...__... 4.00 ._..."......
500/$15.00 .................._._......................._ ...........-. ........._..... ....... Urinal.... Interceptor.... Water Softener.... ._.......1............ 4.00 .............
Signs with I XFMR ........ ......................_... _......._..- 2.00 -....---- Plumbing Piping without fixtures ......"...._.._...."...._..._. 4.00 -
...........".
Each additional XFMR/Time Clock ... ............. - .50 . ......... Misc. ........_.........................._............_...............:.............. ......... _..."......
Annual Electrical Maintenance ....... ..._... 25.00 .. .............. Permit Fee ............__....._....................................-........--1 6.00
Other (see Ordinance Current) ............. ...-....._................. -........... TOTAL PLUMBING PERMIT FEE (plus penalty if app. p) 3
___...... ................. .........._.. APPLICATION F• . HEATING/COOLING
.. .....
Permit Fee ..............................................._.......-.............. $ 6.00 PERMIT INSTALLATION NO. EACH FEE
TOTAL ELECTRICAL PERMIT FEE(plus penalty if app.O) $ Forced Air Unit...._.........to 100M --......... .--... $ 6.0D -- - -
INSPECTION • s over 100M -.._............. ........ 10.00 ....._........
Comfort Cooling Unit_ to 3 ton/HP...._........... .....-.. 6.00 ...............
Forms / Foundation............................... By:..._............, Date:................ to l5 ton/HP............._............ 9.50 ..._.........
Plumbing Ground Work ....._................_........._._......................_........... - to 30 tan/HP.__.._....__ ....._...12.00 ...............
-'lough Electrical ......__. ............... .................._......................_....... to 50 ton/HP......_...._.. _........ 17.00 .._.._.._...
...........
Yeme - Plumbing and Heating ........... ...........................--.............._... Space Heater....._. Wall Heater .L................................ _.6.00 ..__.........
nsulation / Energy"..............."_._._...... ....................... _........_."_._...._.. Flues - other than above .............--......._........_............3.00 ......_.......
GasTest ......._...................._......_..................................-...................... Vent Fan: Kitchen........ Bath ..........................._...._._. ...3.00 ...............
Temporary Power Gas / E loci.._......................................................... Commercial Range Hood 6.00 _..............
Final - Electrical ....-........_........_-.........................._.......... Misc. .......................................-..........................................._....._.........
Final - Building / Mechanical ...................................... ........................... Permit Fee _..................................................................... $ 6.00
Final - Design Review / Landscaping ""._.."_."......._....._............""......... TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. C)) $
Final - Public Works..........."...............................................