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1472Plans Received By .............. f.Y.1':f............... ............ Date f..VAR .d�!!.. REO.: Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach..... Plans Checked By ....................n. , ,r! Application Approved By. ...... .. pz.. �1........................... Date ...... Date j�!f..� Validated By .......................... Date ......................... Compensation Certificate Verified By .................... Date ..................... - e, Kai MU:. $ A 613 00 Permit Fee (plus penalty if applicable) ........................ $....s1�.....�.... Plan Check Fee (less deposit of S.......... Rcl. #..........) $....................... Energy Plan Check Fee (Dep. of $........ Rct. #........) $............... StrongMotion Fee .......................................................... $........ ,,i------- Plumbing Permit Fee ................................................ $....................... ElectricalPermit Fee ............,_ ....:.......................... ..... ...... $....................... Mach. Htg./Coolg. Permit S .::..;.:.n_-... .............. $....... ...._.......... Construction Tax........... .. r': ..........$ ....................... Sewer Conn. Fee .............. CWater Conn. Fee .............. $- ........... ........ . Landscape Fee Fee .................... Street �Tree,Fee ............ $.... .. �.... Mise .........................._......................:................. $....6............... Type Const......... Group........ Div......... Occ. Load........ No. Exits........ Floor Loads: let.... 2nd.... Other.... Sprinklered.... Area Sep. Walls.... ZONING REQUIREMENTS Environmental Status: Exempt............ Other ........................................ Design Review Approval: Bldg. - .......... Site ............ Sign ............ Use Zone ............ P.D. Conditions............................................................ Cond. Use Permit e...... Variance e...... Parking Spaces.... Load. Sp..... rovedBy ........................................................... Date ........................... /rwalms• roachment Permit ........................ Grant of Easement........................ urb, Gutter, Sidewalk,. Driveway: Replace Repair Sewer............ Conn. Fee $................ Water................ Meter $ ................ Agreement for Completion of Public Works Improvements .................. Plans Checked By........ Date........ Approved By........ Date .................... PERMIT INSTALLATION NO. EACH FEE Light Outlets............ Switches............ Fixtures............ Receptacles............ TOTAL NUMBER (less than 1000 watts) ..................... $ .50 ...... Range........ Cooking Unit........ Oven ........... ................. 2.00 ........... Dryer.... Garb. Disp..... Dishwasher .... ........ ............. ....2.00 ........... SERVICE OR TEMPORARY POWER to...... .. . ... 2,00 , ..... .......... 100 amp/$5.00, 200/$7.04.'500/$9.00 800/$20.00, 1200/$40.00............................................................ MOTORS, Generators, Welders, Heaters, per HP-KW-KVA to 1/$2.00, 5/$3.50, 20/$8.50, 60/$10.00, 100/$12.00, 500/$15.00...................................................................................... Signs with I XFMR...................................... ............. ... 2.00 .. .......... Each additional XFMR/Time Clock .. .................50 .. .......... Annual Electrical Maintenance .................25.00 ........... Other (see Ordinance Current) PermitFee........................................................................ $ 6.00 TOTAL ELECTRICAL PERMIT FEE (plus penalty if app. ❑) $ Forms / Foundation ............................... By:.................. Date%.. Aumbing Ground Work .................................................. ............. me - Plumbing and Heating.............................................................. �"•ign / Energy .................................................................................................. 'ower Gas / Elect............................................................... .'al ........................................................................................ / Mechanical.................................................................. view / Landscaping.................................................... . ks........................................................... PERMIT NUMBER I I$Z7 FAPPLICANT TO FILL IN OR ADDRESS OF PROJECT: L..o..3..9.3........%......../-.................................... Legal Description: Tract ...................... Block............ Lot...................... Description of Work: 4.z celf....✓ .... .... .. fat Struct. Improvement on Parcel: Yes.... No.... Area of Bldg....... Separate Structure............ or Addition/Alteration to Exist. Bldg........... No. of Stories.. ....... 11 ..... Use of Building.................................................. Valuatigg.of Projec$.....20.o..r....................................... .. Owner:/p.✓[Q... ..KQ.e.i.......4.✓�. .���..�.........._. Phonlyzw'..>3...laQ. Contractor�x. sc". Nom' Lic. e ................................ AddressZ3 Phone: .................... Z,3 .ct3.p�r .. �................... Contractor - E eclrlcal:.�...................................... ............................ City Business License a .................... Phone:.................... Plumbing: .................................................................... . ............... City Business License •.................... Phone:.................... Heating and Cooling'.................................................................. City Business License e .................... Phone:.................... Architect/Designer: .................................................. Phone:.......:............ Engineer: ............ - ..................................................... Phone:................. Lender: 2nknown ........ ............ "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 as to become subject - the workma ' penaetlon laws of California."""" ��' SIGNATURE OF �. ' APPLICANT/OWNER�/•...�......... OAT/QI// ..... I certify that AAAA111lssss WWWWease applicant I am licensed under the plf!VA0jewsgA8 Contractors License La nd further that my License NO. Gii 3-= Ag In ClassifIcation.... ...... a. ...................... Is in full force and effect: or ............ I cenity that I am exempt from the "Licensed Req.'•ad" provisions of the Contractors License Law. (State basis of exemption., I hereby acknowledge that I have read this application and state that the above is correct and agree to comply with all City Ordinances and State Laws 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 nsequencA of the granting of this permit, SIGNATURE OF // /�%rS.Lf6 - u�-- APPLICANT/CONTRALTO 4..�.. .. .. OATB l.._..1...__ NOTE: When properly sell ale NU form comuhW Is Building Permit. 'This permit expires and become null and void should work not be eommenad vMW 170 dere from validation date, or should authorized construction be suspended Or abandoned for a period of 170 days after work N commenced. APPLICATIONe PERMIT INSTALLATION NO. EACH 'If FEE Gas Sytem with up to 5 outlets ................................... $ 4.00 ..•..•••..... Each additional outlet .................................. ...... ...: 1.00 ............. Water System (Installation, Aft. 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.$2.00.................................... Vacuum Breakers ............................................ .......... ... 4.50 .. ........ Slop Sink........ Floor Sink........ Floor Drain .... ......... ... 4,00 ........._.. Urinal.... Interceptor.... Water Softener ....................... ... 4.00 , ,,...... Plumbing Piping without fixtures......................�......... ... 4,00 .,,,-----,--- Mi s c........................................................................................................... PermitFee..........................................................................$ 5.00 TOTAL PLUMBING PERMIT FEE (plus penalty if app. ❑) $ APPLICATION- e•HEATING/COOLING PERMIT PERMIT INSTALLATION NO. EACH FEE Forced Air Unit ............... to 100M ................................. $ 8.00 ............... over 100M ............................ 10.00 .............. Comfort Cooling Unit ..... to 3 ton/HP ........................... 8.00 .............. to 15 ton/HP ........................... 9.50 ............... to 30 ton/HP .......................... 12.00 ............... to 50 ton/HP .......................... 17.00 ............... Space Heater........ Wall Heater ...................................... 6.00 ............... Flues - other than above ................................................ 3.00 ............... Vent Fan: Kitchen........ Bath ....................................... 1-3.00 ............... Commercial Range Hood .............. . 8.00 ............... Misc........................................................................................................... PermitFee........................................................................ $ 6.00 TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. ❑) $ I