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1450 CITY OF CM]M W R91 ION APPLICATION FOR COMMERCIAL BUILDING PERMI PERMIT NUMBER !�s� AND CERTIFIC-ATE OF OCCUPANCY FOR APPLICANT TO FILL IN BUILDING INSPECTION DIVISION STREET ADDRESS OF PROJECT: �'...../D 900 TO.r/ Q v.... ....................__....... .................... Plans Received By.................................................... Date ......................... Legal Description: Tract........................ Block............ Lot...................... REO.: Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mech..... Description of Work: .......................__..........._......_..........._.................. Plans Checked By.........._.........._ ...._..._..._Date .................. 1st Struct. Improvement on Parcel: Yes.... No.... Area of Bldg............... Application Approved By__....... L...4.............. Date Separate Structure............ or Addition/Alteration to Exist. Bldg........... Valldated By......... ................................................Date ........................ No. of Stories......... Use of Building ................_........._..................... Compensation Certificate Verified By....................Date .... Valuation of P Jact $. .... ................. • . • . $ O ....... ..... Phone:.................... Permit Fee (plus enalt if a licable $............._........ Contractor: ..h+ .bh. ....L.`�/ •. . City Bus.Lic. 0_............ Address: .14lZ3..,eoQ.G.vS.,......J'.... ............ Phone:. .9............ Plan Check Fee (less deposit of$.... ._.. RCL #._..._.J $......._..._..._.... Contractor - Electncal: Energy Plan Check Fee (Dep. of $........ Rct. #.......-) $....................... City Business License +r.................... Phone:.................... StrongMotion Fee ......... _.............................._.............$....................... Plumbing: Plumbing Permit Fee .._............. ,.`;••11;10--....$--40­(".czl. City Business License �..........._....... Phone:_........_........ Electrical Permit Fee ...... ......... .....Ce.....'..........__...$... ... .... �•y .._...... Heating and Cooling _............................................_.................. Mach. Htg./Coolg. Permit $ .......................r......$..:2..,..0 .... City Business License 0.................... Phone:.................... Construction Tax.................. �f ....1`10V.....$..._................... ff•• I Architect/Designer: ......................................___...... Phone:.................... Sewer Conn. Fee ........_.._.Weter)Gonn. Fee ..............$.............. ........ Engineer: Phone:............... Landscape Fee ...............:.... Street Tree Fee ..... $._.__._...._...... ...._............._....._.........�].Unknown P Lender: _..__._..................._.........._.. ............... Misc. Fee .__....._........................_{]....�t1._�..............$....................... _ ..I coni/y that in the performance of the work for which this permit Is $ 3/• �'0 "" Issued I shall not employ any person In any manner so ee to become subject to the workman's compensation laws of Celilomia" Type Const.. Group........ Div......... Occ. Load........ No. Exits........ SIGNATURE OF Floor Loads: 1st.... 2nd.... Other.... Sprinklered.... Area Sep. Walls.... APPLICANT/OWNER .................................................................... DATE ............................ REQUIREMENTSZONING ......... I certify that as the applicant I em Ilceneed under the provisions of fed Contractors Licensg esu end luri er that my License No. ............................ Environmental Status: Exempt .__... Other................... In Classlflcetlon _.L.. .B..k-:S'.�. ....... le In fun force and effect: or ..... .._.n ............ the Design Review Approval: Bldg. Site Sign --- oernty that I anten exempt from the i Licensed Rtion., " provisions of '""""""'"'" ""'"'-"" """""" Contractors License Law. (State belie of exemption., Use Zone ............ P.D. Conditions ......... ................... ............................. I hereby acknowledge that I have read this application and stale that the above Is Cond. Use Permit r...... Variance a...... Parking Spaces.... Load. Sp..... correct and agree to comply with all City Ordinances and State Lewd mqulsting Approved By........ Date ........_................. building. _ I (We) agree to save, Intlamnliy and keep harmless the City of Cupertino •" • agalcst liabilities, judgments, costa and expenses which may in any way acture against said Cit y In ons uence of the ranting of this permit. ncroachment Permit........................ Grant of Easement........................ SIGNATURE OF Curb, Gutter, Sidewalk,. Driveway: Replace Repair APPLICANT/CONTRACTOR . . ...... ........._.. ....... .. ..... AT¢`y1...:.p....�(...�.. Sewer............ Conn. Fee $................ Water................ Meter $................ NOTE: When property val led this form constitutes a euRdIng PermN. This Agreement for Completion of Public Works Improvements permit expires and becomes null and void should work not be mrrnenced within Plans Checked By._...... Date........ Approved By.... Date 130 days from validation dela, or should authorized construction W suspended or - abandoned for a period of 130 days after work Is commenced. APPLICATION • • ELECTRICAL PERMIT PERMIT INSTALLATION NO. EACH FEE • • • PLUMBING PERMIT L�ghl Outlets............ Switches............ PERMIT INSTALLATION NO. EACH FEE Fixtures............ Receptacles............ Gas Sytem with up to 5 outlets ................................... $4.00 - - TOTAL NUMBER(less than 1000watts) ... ............. ....$ .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/$6.50, 50/$10.00, 100/$12.00, Slop Sink........ Floor Slnk........ 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 .. ............... .50 . ....._....... Misc _ . ...._........_.................._...... ._........................ ..................... ............. Annual Electrical Maintenance . ...._......... 26.00 .. ..........__ Permit Fee ..____............................................................. $ 6.00 Other (see Ordinance Current) .......I ............... .............. TOTAL PLUMBING PERMIT FEE (plus penalty if app. 0) $ o,0'd ._.................... .................................... ...._.................._... ....._........ APPLICATION • • HEATING/COOLING Permit Fee ........................................................................ $ 6.00 PERMIT INSTALLATION NO. EACH FEE TOTAL ELECTRICAL PERMIT FEE(plus penalty if app.0) $ Forced Air Unit...............to 1DOM .................................. $ 8.00 ............... INSPECTION • • • over 100M .................... ........ 10.00 ............... 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 _ .......... 2.0000 ............... Pough Electrical ...._........... ................... .. .._.........._............. to 50 ton/HP. . 17 .............. time - Plumbing and Heating .............................................................. Space Heater........ Wall Heater ....____............. ............6.00 ............... „sulation / Energy............................... ... Flues - other than above ...................................-............3.Oo ............... Gas Test ..._......................_.........._........ fJ'3.77A.... Vent Fan: Kitchen........ Bath­ eth .........................._.-......... ...3.00 .._...-_... Temporary Power Gas / Elect............................................................... Commercial Range Hood B.00 Final - Electrical ................................................................................_...... Misc. ........�.D.c.�r..:r'.!�c.....�........ ...............................__.-.--.... Final - Building / Mechanical .................................................................. Permit Fee .................}........._ ..-.....-..........-.................. $ e.00 Final - Design Review / Landscaping .................................................... TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. 0) Final - Public Works...........................................................