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1688 • � CITY OF CUPERTINO APPLICATION FOR COMMERCIAL BUILDING PERMIT PERMIT NUMBER AND CERTIFICATE OF OCCUPANCY FOR APPLICANT TO FILL IN TIOdLD11L1810 STREET ADDRESS OF P OJECT: s e Plans Received By........ ...__._..._......___..........._...Date _....................... Legal Description: Tract... lock_...... Lot...................... REO.: Plans.... Survey.... Calcs: Struc.....*Energy.... Elect..._ Mach.... Description of Work: .. ...�A&4A r................................ Plans Checked By...................................�.1 L Date / ........p tat Struct. Improvement on Parce . Yes.... No.... Area of Bldg............... Application Approved By.... ...............L7.r...._..._.Date ..... /7 p.s Separate Structur .._..._... or Addition/Alteration to Exist. Bldg........... Validated By.........................__._......__.......__._....,Date ........................ No. of Stories.....11...._. Use of Building .................................................. Compensation Certificate Verified By....................Date ......................... Valuation of PVject: $.................. .......................................................... e e $ Owner: .. a".2A..V(,,W ( 1Pd_... Phone:...,,.11...... Permit Fee (plus penalty if applicable) .......... ......$......... Contractor: . '(....13{ oWiV—...... Cit Bus.Lic.�'......{kr'941............ S Y ..... v ...A ... Phone:.9. Plan Check Fee (less deposit of$.... Rct. #..........)$...._......_......._ Contra s: ..... Electrical: -- uG. . .• c.... :Q(a'orJ10D Energy Plan Check Fee (Dep. of $........ Rct. #.... Contractor - Elect Bustness............e #....... Phone:...... ..................._... Strong Motion Fee ...................... P���l .........._.......... City Business License ...................— Phone:.................... Plumbing Permit Fee CI.IY...Vr" Plumbing: ................................ ............................. :..--................ ................................................$.... .... . ....... City Business License #.---................ Phone:..................-. Electrical Permit Fee ......................... 9 $..../1.� ... Heating and Cooling T� ^ .................................................................. Mach. Htg./Coolg, Permit $ ...... rrM...... ..�...... yi ....................... City Buslneep�,� License #,. ........ Phone:.................... Construction Tax.............. ..............................$....................... Architect/Designer: .......pyQYYtN..y' Phone:.................... Sewer Conn. Fee .............. Water Conn. $....................... ........... ���.... Engineer: ..........__................._......_.__...................... Phone:.......... Landscape Fee .................... Street Tre .............$............. ......... Lender: 0.Unkriowh Mise. Fee .......................................................................$........_..........— ^I certify that In the performance of the work for which this permit Is NNIIIIKe . , $ Issued I shall not employ any person in any manner so as to become Subject to the workman's compensation Tawe of California." Type Const......... Group........ Div......... Occ. Load........ No. Exits........ SIGNATURE OF Floor Loads: 1st.... 2nd.._ Other.... Sprinklered.... Area Sep. Walls.... APPLICANT/OWNER ......................._...._........-..................._..... DATE ..............--........ e e ............ I certify that as the applicant I am licensed under the provisions of the Contractors License Law and further that my License No. ............................ Environmental Status: Exempt ............ Other............... ........... in Classification ..............---................... Is in full force and effect: or ... Design Review Approval: Bldg. """""' " Site Sign �.........I. I certify that I em exempt from the "Licensed Req.'•atl" provisions oft e """"" """-"- Contractors License Law. (State basis of exemption., Use ZORB ............ 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 Slate Laws regulating ApprovedBy.................. ........................................ Date .._...................... building. I (We) agree to save, indemnify and keep harmless the City of Cupertino Encroachment against liabilities, judgments, costs and expenses which may in any way v occurs against said City in rp aequenc(1of ting of this permit. PBrmit__................... Grant OC Easement..............._....... SIGNATURE OF !//// )s e yy Q^ Curb, Gutter, Sidewalk,. Driveway: Replace Repair APPLICANT/CONTRACTOR ... .. . . . . ..... DATE J..,V- J & Sewer............ Conn. Fee $................ Water................ Meter $................ NOTE: When properly validated this land constitutes a Building Permit. This Agreement for Completion of Public Works Improvements .................. permit expires and becomes null end void should work not be cammeneed within 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 commenced. e e- PERMIT INSTALLATION NO. EACH FEE Light Outlets............ 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 TEMPORARYPOWER to ...... .... 2.00 Lavatory.... Shower Pan.... Bathtub.... Sink........ .......... 3.00............... . ...... . 100 amp/$5.00, 200/$7.00, 500/$9.00 15910 Wash. Mach..... Dishwasher.... Garb. Disp..... .............. 3.Oo ............. 800/$20.00. 1200/$40.00 ................................... .................or...— 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 ............................................ ..........I.-.- 4.50... .. .....20/$6.50, 50/$10.00, 100/$12.00, Slop Sink........ Floor Sink........ FloorDrain .... ............ a.00500/$15.00a.00................---........................... .............. ............ ..... Urinal.... Interceptor.... Water Soften er.... ..................-... ............. Signs with I XFMR .......................—........—. ................ 2.00 .. .............. Plumbing Piping without fixtures .................................. 4.00 ............. Eachadditional XFMR/Time Clock -. ........ .... ... .50 ...._.......... Misc. ................................................................................ ........-'-----'-' Annual Electrical Maintenance . .............— 25.00 .. .............. Permit Fee ..........................................................................$ 8.00 Other (see Ordinance Current) ._............... _............................. .......... TOTAL TOTAL PLUMBING PERMIT FEE (plus penalty if app. Ej) $ Permit Fee ........................................................................ $ 6.00 PERMIT INSTALLATION NO. EACH I FEE TOTAL ELECTRICAL PERMIT FEE (plus penalty if app.p) $�/x AD Forced Air Unit...............to 100M ................................. $ 6.00 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...............-..........12.00 ............... ugh Electrical ..................................... ................................................... to 50 ton/HP.......................... 17.00 ............... T Was - Plumbing and Heating .............................................................. Space Heater........ Well Heater .....—..............................6.00 ............... insulation / Energy............................... .................................................... Flues - other than above .................................... ............3.00 . .............. GasTest .............—.................................................................................... Vent Fan: Kitchen........ Bath .....................................-.....3.00 ............... Temporary Power Gas / Elect............. Commercial Range Hood 6.00 .-,,,,,........ Final - Electrical ..................................... ......................... Misc. ........................................................ Final - Building/ Mechanical .................................................................. Permit Fee .............-. .................. $ 6.00 Final - Landscaping Design Review / 9 P 9 -.........................-...—.................. TOTAL Hig./ Coolg. Permit Fee (plus penalty if app. O) $ Final — Public Works...........................................................