1589 PERMIT NUMBER
, . APPLICANT TO FILL IN
i
ST"fj ADDRESS OF JECTA
Plans Received By....................................................Date ......................... Legal Description: Tract...... Blo ......... Lot......................
r
REQ.: Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach..... Description of Work: ......../....�-.G�.�.\........ ..'-M, —
Plans Checked By....................................................Date ......................... 1st Struct. Improvement on Parcel:Yes....No.... Area of Bldg...............
Application Approved By... ...... Date ......................... Separate Structure............ or Addition/Alteration to Exist. Bldg...........
Validated By....................'PZ........................Date ...//:7-/-#:7J'4.. No. of Stories............./) Use of Building . ... ........ . .. .. ..
Compensation Certificate Verified By.................o Date ."....................... Valuati6rl ofl Projeot:l S. . .-d'� .. .... .. Phone3.................
7(J (�J
• • •• • E o20� Owner: . ..en.t.. . .... . . .. ... .. .. ............ Phone:....................
Permit Fee (plus penal II applicable) — Contractor: . //�� .. .. City .
penalty pP ) ........................$...�J.:_ ..... Address: ....rYb.
EEt:: . .... ...... 0........ e:............
Plan Check Fee (less deposit of$.......... Rct. #..........)$....................... Contractor - lectrlcal: ....................""........................................................
Energy Plan Check Fee (Dep. of E........ Rct. #........)$............. �_ City Business License #.................... Phone:....................
Strong Motion Fee ..........................................................$........../..jv
.......... Plumbing: ......................................................................................
Plumbing Permit Fee ................................................$....................... City Business License #.................... Phone:.................... .
Electrical Permit Fee ......................................................$........................ Heating and Cooling
........................................... .................... 1�
Mach. Hig./Coolg. Permit $ ..............................$................... City Business Elastase #.................... Phone::....................
Construction Tax.............................................$....................... Architect/Designer: .................................................. Phone:....................
Sewer Conn. Fee .............. Water Conn. Fee ..............$....................... Engineer: ....................................................7................ Phone:...........
Unknown
LandscapeFee .................... Stre t Tree Fee ............$...................... Lender: .................................................................................... .............win
Misc. Fee ................................�}.�. ................."......$...... ... "1 certiy VR
e p dormance of the work for which this permit Is
............
. , , : $ f �•y () Issued I snpl ny person In any manner ao m to betom subl of
to the work e a lion laws of CaIifomie." I
Type_Const......... Group........ Div.... ... Occ. Load........ No. Exits........ SIGNATURE OF 1/Q j
Floor Loads: 1st.... 2nd.... Other.... Sprinklered.... Area Sep. Wells.... APPLICANT/OWNE .. .... .. ....... ............... DATE........(/........ ....... t
- s ............ I certify frac that as the aDPland I he that my under the provls one of the l
Contractors Elastase Lew and further that my License No. ............_.............
Emtkonmental Status: Exempt............ Other....................... in Classification ..............................._....... is in full force and effect:or
'n ............ ............ I certify that I am exempt from the"Licensed Rea.'•ed"
' Design Review Approval: Bldg. ............ Site .....""..... Sign provisions o the
"""""" Contractors License Lew. (elan is application
of exemption.,
Use Zone".......:.... P.D. COnd1110nS ............................................................ I hereby acknowledge that I have read this appllcetlon end state that the above is )
Cond. Use Permit r......Variance r...... Parking Spaces.... Load.Sp..... correct and agree to comply with all City Ordinances fend State Laws regulating
oved.By.................."...................""................... Date ....................:...... building.
.! - I (We)agree to save, Inde fy an eap harmless the City of Cupertino
" - � ' s against liabilitieslud9 s, o s and expenses which may in any way
eccure against said CI n c a e ce of the granting oft a Pe mit.
roachment Permit........................ Grant of Easement........................ SIGNATURE OF
rb, Gutter, Sidewalk,. Driveway: Replace Repair APPLICANT/CONTRA a r. ... ...... ._... ... . ....... .l� ...fiend..__.
Sewer............ Conn. Fee $................ Water.............."" Meter$................ NOTE: When properly vNldetatl this form comUtutas ■ Suiltl Permit. This
Agreement for Completion of Public Works Improvements .................. permit expires and becomes null and void should work not be commenced whin
Plans Checked By........ Date........ Approved By....".." Date.................... 120 days from validation data, or should authorized construction be suspended or
abandoned for a period of 120 days after work Is command.
• ••
APPLICATIONs• PLUMBING PERMIT
PERMIT INSTALLATION NO. EACH FEE
Light Cutlets............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.................._,....................... 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.... 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. Disp.................... 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 ................ 4.00 .............
500/$15.00 ............................................................ ............................... Urinal.... Interceptor.... Water Softener.... ...................... 4.00 .............
Signs with I XFMR ...................................... ................ 2.D0 ................ Plumbing Piping without fixtures ...................... ..........". 4.00 .............
Eachadditional XFMR/Time Clock .. ................ .50 ................ Misc. .............."".................................................................... .....................
Annual Electrical Maintenance .................25.00 ................ Permit Fee ..........................................................................E 6.00
Other (see Ordinance Current) .................. .............................. .............. TOTAL PLUMBING PERMIT FEE (plus penalty if app. ❑) E
.............. APPLICATION •• HEATING/COOLING
..................:............"....................................................... ................................
Permit Fee .............".......................................................... $ 6.Do PERMIT INSTALLATION NO. EACH FEE
TOTAL ELECTRICAL PERMIT FEE(plus penalty if app.❑) $ Forced Air Unit...............to 100M ................................. $ 6.00 ...........••••
INSPECTION RECORD - over 100M .................... ........ 10.00 ..............
Comfort Cooling Unit.....to 3 ton/HP............................ 6.00
.
Forma / Foundation............................... By:.................. Date:................ to 15 ton/HP........................... 9.50 ..............
�bing Ground Work ............................. ............................................ to 30 ton/HP.......................... 12.00 ...............
hElectrical .............................................................:.......................... to 50 ton/HP.......... .......... 17.00 ...............
e - Plumbing and Heating .............................................................. Space Healer........ Well Heater ......................................8.00 ...............
ulation /Energy................................................................................... Flues - other then above ................................................3.00 ...............
Test ................................................. ................................................... Vent Fan: Kitchen........ Bath ..........................................3.00 ...............
.................................. ........ .
Temporary Power Gas / Elect............................................................... Commercial Range Hood . 6.00 ...............
. .
Final - Electrical ........................................................................................ Misc. ...................................................
........................................................
`nal - Building/Mechanical .................................................................. Permit Fee ........................................................................$ 6.00
'•� 'r - Design Review / Landscaping .................................................... TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. ❑) S
Public Works...........................................................