07070158CITY OF
CUPEkTINO
CITY OF CUPERTINO o too Z 00 56,
PERMIT ,APPLICATION FORM ---
a7o70/-��
APN # Q' �}/�
Date: f) G
Building Address: 1 o 5-3-57 6A S eSiz j,v i �Nlailing Address (if different from building address):
Owner's Name:
Jq",/,J FAr2iO)AJ/
Phone #:
()toS).37 -- 1(,� 1-7 z/
Contractor:
License #: (02-0)-5-0
Contact: Phone: 9
Cupertino Business License#:
J,q14A-d rAo2i" NiA Fax: L- 3)02-
)oZBuilding
Boiler > 100K to 500K Btu
BuildingPermit Info: S hee / _I / S - K Fo- ba&e- �1?� S Wa1/l
Re vl :sect T - �,J
Bldg❑ Elect El Plumb ❑ Mech El
Job Description:
Residential ❑ Commercial ❑
Sq.Ft. Floor Area:
Sq.Ft.:
Cost of Project: /
OccupancyGroui:
Type of Construction:
Please check this box if the project is a
❑
BCONSTAX
second-storyaddition:
Project Size: Standard ❑ Large ❑ Major ❑
BCONSTAX
Quantity Fee ID
Fee Description
Fee Group
BAPPLOTHER
Other Appliances
MECHANICAL
BBOILER1
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
Energy Add Multi
BUILDING
BINVESTIGA
Investi ation fee
BUILDING
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