1753 ITY. OF. CUPERTINO
JAIh 1981 PERMIT NUMBER /7S3
FOR APPLICANT
- ADDRESS OF PROJECT:
r
Plans Received By....................................................Date ......................... Legal Description: Tract........ .... . Block. .......... Lot.....................
REO.: Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach..... Description of Work:Xl?1S.t.3_._T.._.SPK heads tri .... :I
................................ .
Plans Checked By....................................................Date ......................... tat Struct. Improvement on Parcel:Yes.... No....Area of Bldg...............
Application Approved By.........................................Date ......................... Separate Structure............ or Addition/Alteration to Exist. Bldg...........
ValidatedBy..............................................................Date ............._..._..... No. of Stories................ Use of Building ..................................................
Compensation Certificate Verified By....................Date _....................... Valuatio of P e t: .)r....,a 3. .�. �......--............ ........ ..
$ (r--C owner:kTor ° ..... sso.c a..:e. ................ Phone:�:4�:2: 11
Contractor:�agG. }ryr,cmp$ City Bus. . #.............
Permit Fee (Plus penalty if applicable) ............... $ A.....�.._... Address:y-.J.1..6....JCO;t)C ZVa_,..-. ; Phone:2.4.9:-Z8.' 1
Plan Check Fee (less deposit of$.......... Rct. #--........)$..� ...)-c?..... Contractor - Electrical: ................................_......... ............................
Energy Plan Check Fee (Dep. of $........ Rct. #........)$...................... City Business License #.................... Phone:....................'
Strong Motion Fee ..........................................................$.......r...f"`..`:....._ Plumbing: ..................
....................................................................
Plumbing Permit Fee ................................................$.............._....... City Business License #.................... Phone:....................
Electrical Permit Fee ......................................... ------$....................... Heating and Cooling .....
Mach. Htg./Coolg. Permit $ ..............................$.....__............. City Business License #--------------..... Phone:............
Construction Tax.............................................$....................... Architect/Designer: Phone:....................
Sewer Conn. Fee .............. Water Conn. Fee ..............$....................... Engineer: .................................................................... Phone:.......
LandscapeFee .................... Street Tree Fee ............$.......... Lender: ......................... ................................................... .....n....n..o..w...n..
Misc. Fee ........................................................................$.... "I certify that in the Performance of the work for which this permit Is,
issued I shall not employ y pawn in any manner so as to become subject
s $5�" anto the workman's compensation laws of California."
Type Const......... Group........ Div......... Occ. Load........ No. Exits........ SIGNATURE OF -
Floor Loads: 1st.... 2nd.... Other.... Sprinklered.... Area Sep. Walls.... APRICANT/OWNER ...................__.........................._.................DATE....._..._............
ZONING
REQUIREMENTS ... ....... I certify that as the applicant I ern licensed under the pmmvv��sslIoopppp QQf the
Contractors License Layy((an.Q%y,cher that my Ucanae No. 1.1 welt..._
Environmental Status: Exempt............ Other............... In Classification ...........S,w..:..l.W........... Is In full forte and effect:or .
` ----- I certify that I am exempt from the "Licensed Req.'red" provisions of Me
Design Review Approval: Bldg. ............ Site ............ Sign ............ Contractors License Lew. (State basis 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 Lewis regulating
ApprovedBy..........:............................................... Date _......................... building.
I (We) agree to save, indemnity and keep harmless the City of Cupertino
• •• • against liabilities, ludg n t tmxpeas which may In any way
roechment Permit..................... Grant of Easement........................ ng of this perrQmity.. �Urb, Gutter, Sidewalk,. Driveway: Replace Repair APPLICANT/CONTRACT accure again Bit said Cit o DATE��Z.II�.t.S.i,.
SIGNATURE OF
Sewer---......... Conn. Fee $................ Water................ Meter$................ Permit. ,
NOTE: When and bec meas pull
and
form consulates wrk no Be cnge ssill .Tltls
Agreement for Completion of Public Works Improvements .................. permit expires and baeoma• null ane reM should work iiM M COrrair•irwtl lsllltlir'
Plans Checked By........ Date........ Approved By........ Date.................... 120 days from validation deb, or should wMorised construction be srwpaiitlW_or .3
abandoned for a Period of 120 Frye alter work Is commenced.= :. ,�,;^•:;.,,r::"="'�
APPLICATION •• ELECTRICAL
APPLICATION •• PLUMBING PERMIT
PERMIT INSTALLATION NO. EACH FEE :
Light Outlets............ Switches............ PERMIT INSTALLATION IIFEE',r
Fixtures............ Receptacles............ Gas Sytem with up to 5 outlets ........................... _.....$4.00 .' ,
TOTAL NUMBER(Iess than 1000 watts).....................$ ,50 .............. Each additional outlet ................................. .......... 1.00 .::..i:....-
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 .----I.......... 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/$15.00 ............................................................ ............................... Urinal.... Interceptor....Water Softener.... ...................... 4.00
Signs with I XFMR .................:.................... ................ 2.00 ................ Plumbing Piping without fixtures .....................-�............ 4.00 .............
Each additional XFMR/Time Clock .. ................ .90 ................ Misc. ................................................................................. ."
............ ..:..........
Annual Electrical Maintenance . .................25.00 ................ Permit Fee ..........................................................................$ 6.00
Other (see Ordinance Current) ................................................ .............. TOTAL PLUMBING PERMIT FEE (plus penalty If app. ❑) $ .: 'a•;.�
............................. .._........ APPLICATIONFOR HEATING/COOLING PERMIT
.......................................................................................................
....
Permit Fee ........................................................................ $ 6.00, PERMIT INSTALLATION NO. EACH °FEE v
TOTAL ELECTRICAL PERMIT FEE(plus penalty if app.❑) $ Forced Air Unit...............to 100M ................................. $ 6.00 ...............
INSPECTION RECORD over 1DOM .................... ........ 10.00 .......a......
Comfort Cooling Unit.....to 3 ton/HP................. .......... 6.00 ......_....
...
Forms / Foundation............................... By:.................. Date:................ to 15 ton/HP........................... 9.50 .......:........
Plumbing Ground Work ............................................................................ to 30 ton/HP......:...................12.00 ...............
—"Rough Electrical ........................................................................................ to 50 ton/HP.......................... 17.00...............
me - Plumbing and Heating ...................................................:.......... Space Heater........ Wall Heater ....:.................................6.00 ...............
ation
- other than
s ITest /.Ener9y.................................................................................. Vent sFan: Kitchen.......Bath ..............I.........._....._........3 00 ._.........::
Temporary Power Gas /Elect............. Commercial Range Hood .,-..-- ,., 6.00 ..............
Final - Electrical ....................._................................................................. Misc. ...........................................................................................................
Final - Building/Mechanical .................................................................. Permit Fee ........................................................................$ 6.00
Final - Design Review / Landscaping --..------.-..--•-.-...I...-...-.--..--------.--_ TOTAL Hig./ Coolg. Permit Fee (Plus penalty if app. ❑) $
Final — Public Works...........................................................