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1363Plans Received By ................................................... Date ......................... REO.: Plans.... Survey.... CaIcs: Struc ..... orgy.... Elect..... Mach..... Plans Chocked By........................ Date (lfL Application Approved 7 Date Mw Validated By ................ - ................ J, ........................... . Date ....................... Compensation Certificate Verified By .................... Date ......................... $ Permit Fee (plus penalty it applicable) ........................ $....................... Plan Check Fee (less deposit of $.......- Pct. #.....-..) $ ....................... Energy Plan Check Fee (Dep. of $........ Rct. #........) $ ....................... Strong Motion Fee .................................. ......... $...... Plumbing Permit Fee ...........w .......... I ...... L . Electrical Permit Fee ....._.._.................... . .......... $... . ...... Mach. Htg./Cooig. Permit $ ....................... Construction Tax ................... �..T: ....................... $. .............. ....... Sewer Conn. Fee .............. Watfir conn.#Fe:!7,. $....................... Landscape Fee .................... Stre;I-Tree_ Fee'...:........ $ ....................... Misc. Fee ................................................... .................... $.-.................... $ 2 3 . On Type Const......... Group........ Div......... Occ. Load........ No. Exits........ Floor Loads: 1st.... 2nd.... Other.... Sprinklered .... Area Sep. Walls.... ZONING REQUIREMENTS I Environmental Status: Exempt ....... - ... Other ...... ................................. Design Review Approval: Bldg ............. Site ............ Sign ............ Use Zone ............ P.D. Conditions ............................................................ Cond. Use Permit e...... Variance a...... Parking Spaces.... Load. Sp..... provedBy ........................................................... Date ........................... Irroachment Permit ........................ Grant of Easement ........................ urb,. Gutter, Sidewalk, Driveway: Replace. Repair Sewer............ Conn. Fee $ ................ Water................ Meter $ ................ Agreement for Completion of Public Works Improvements .................. Plans Chocked By........ Date........ Approved By........ Date .................... PERMIT INSTALLATION NO. EACH FEE Light Outlets............ Switches............ Fixtures............ Receptacles............ TOTALNUMBER (lessthan 1000watts) ... ........... $ .50 .. ......... Range........ Cooking Unit........ Oven ........ .. ....... ... 2.00 .......... Dryer.... Garb. Disp ..... Dishwasher .... ....... ............. .... 2.00 .......... SERVICE OR TEMPORARY POWER to............. ... 2.00 . ......... 100 amp/$6.00, 200 7.00 500/$9.00 800/$20.0. 12 . .................... ............. ...... I .........7-t f MOTORS, Generators, Welders, Heaters, per HP-KW-KVA to 1/$2.00, 5/$3.50 ' 20/11118.50, 50/$10.00, 100/$12.00, ....... 500/$15.00 ................................................................25.00..... ......... Signs with I XFMR ............. -- ......... ........... ............. 2.00 Each additional XFMR/Time Clock � . ............ * 50 . Annual Electrical Maintenance .................. Other (see Ordinance Current) PermitFee .................................................. ..................... $ 6.00 TOTAL ELECTRICAL PERMIT FEE (plus penalty if app. 0) $13 UV Forms / Foundation ............................... BY:................. Date:................ g&.!bing Ground W ork ... .. ........ . .... ..... ...... . ......... ....... * ...... h Electrical .. ..... .. ­ ............ * . ...... ***'"*' -­* ..... ........................... ..... * ... ­­ ........ . me - Plumbing and Heating ........... ........................ ........................... ulation/ Energy ............................... ......................... ........................... asTest ................ ................................ ........................ ........................... Temporary Power Gas / Elect . ........... ........................ ........................... Final- Electrical ..................................... .. ..................... ........................... Final - Building / Mechanical ............... ........................ ........................... Final - Design Review / Landscaping ............ - ......... ........................... Final - Public Works ........................................................... qh&T. 514•• e; -18. T, a -ca IS - PERMIT NUMBER F/3L3 FOR APPLICANT TO FILL IN STREET ADDRESS OF PROJECT: --l-o .. 3..!?.3 ..... ..[..0.ilo(-044.�............................................. Legal Description, Tract ...................... Blogk ........... Lot..................... Description of Work: fat Struct. Improvement on Parcel: Yes No.... Area of Bldg ............... Separate Structure............ or Addition/Alteration to ist Bid?. .I No. of Stories.... ff........ Use of Building Valuation Project, $ ........... ...................................... 0 V -o Phone: .................... Contracto4 Contractor - Electrical: ..... ..................... r ........................................... City Business License # .................... Phone:.................... Plumbing:..........- ........................................ ................................. City Business License # .................... Phone:.................... Heating and Cooling .. ....................................................... ........ City Business License # .................... Phone:.................... Architect/Designer:.................................................. Phone:.................... Engineer: .................................................................... Phone:.... Cfhk�6�6 Lender: ................................. .................................................. 0 ................... ............ "I certify that in the performance of the work for which this permit Is d I shall not employ any person In y manner so as to become subject issued m the workman's compensation lam of California." SIGNATURE OF . APPLICANT/OlANER .. IFATEf.�� .............. I codify that . 6th applicant I am licensed under the prUls nsvf t90 - lit my License No. 4fm Contractors Lice Lay fu ar4 in ClasslflcatZ�lv a In full force and affect: or ............ I certili that em exemptI'm the "Licensed Rea,' ad" provisions of the Contractors License Law. (State basis of exemption., I hereby acknowledge that I have Mad this application and State that the above Is correct and agree to Comply With all City Ordinances and State Lam regulating building. I (We) agree to save, Indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may In any way occurs against said City In consequence of the granting of this permit. SIGNATURE OF APPLICANT/CONTRACTOR .4flij ... 00#6013 42. -A.. -B 0 I ateon. NOTE: When property van this farm conalliturtaus a Bulkling'Ps" This permit expires and become n and void should work not be co u IS f"th 120 days been validation date, or should authorized construction be Suspended or abandoned for a period of 120 do" attar work Is commenced. APPLICATION FOR PLUMBING PERMIT PERMIT INSTALLATION NO. EACH FEE I Gas Sytem with up to 5 outlets .......................... .. I .... $4.0o Each additional outlet .................................. ......... . 1.00 ............. Water System (Installation, Alt. or Repair) ..... ..... __ 4.00 ............. Water Closet.... Water Heater.... Ld. Tray .......... .. ...... . 4.00 ............. Lavatory.... Shower Pan.... Bathtub.... Sink ........ ......... . 3.00 ............. Wash. Mach..... Dishwasher.... Garb. Disp ..... .... ......... .. 3.00 ............. Sewer.................................................................... ......... . 8.00 . ............. Lawn Sprinkler Sys. $6.00 Ea. add Sys. $2.00, ........ ........................... Vacuum Breakers ................................. 4.50 ............. .... ­ ..... Slop Sink........ Floor Sink........ Floor 6'rain ..... 4 ............. Urinal.... Interceptor.... Water Softens .......................... 4.00 ............. PI U Fri Piping without fixtures ..... ......... 1...4.001 ............. Misc. .. ....... *­ ........... * ....... * . ........ ­..* .... ......... .. ....................... PermitFee .......................................................................... $ 5.00 TOTAL PLUMBING PERMIT FEE (plus penalty If app. 71) APPLICATION FOR HEATING/COOLING PERMIT PERMIT INSTALLATION NO. EACH FEE Forced Air Unit ............... to 1 DOM ........................ .......$ 6.00 ............... over 100M . ................ ........ 1 10.00 ............... Comfort Cooling Unit..... to 3 ton/H................... ......... .. 6.00 ............... to 15 ton/HP ................ ......... .. 9-50 ............... to 30 ton/ HP ................ r ........ . 12.00 ............... to 50 ton/HP .............. . ......... . 17.00 ............... Space Heater........ Wall Heater .......................... ......... ... 6.00 ............... Flues - other than above ............................ .. .... ......... 3.00 ............... Vent Fan: Kitchen........ Bath ............... . . ... ......... ... 3.00 Commercial Range Hood ........................................... Misc. ....................................................................... ......... .... ........ ............... PermitFee ........................................................................ $ 6.00 TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. [J) $