Loading...
2012 PERMIT NUMBER ao FOR APPLICANT TO FILL IN STREET ADDRESS OFF PROJECT, ............ Plans Received By................................................... Date ...................... Lega-'7�escri lion: Tract............ ........... Block............ Lot...................... REQ.: Plans.... Survey.... CaIcs: Struc..... Energy.... Elect..... pec Description of Work: ................................................................................. Plans Checked By..... ....Dale fill Struct. Improvement on Parcel:Yes.... No.... Area of Bldg............... Application Approved By...... Data Separate Structure............ or Addition/Alteration to Exist. Bldg........... Validated By ................en...................................Date ......................... No. of Stories................ Use of Building .................................................. Compensation Certificate Verified By....................Date ......................... Valuation of Project: $................................................................................ 097.=Gforrfm •• • $ Owner: ............................................................. Phone:.................... Permit Fee (plus penalty If applicable) ........................$•...................... Contractor: ......... ....................... City Bus.Lic. #................................ Address: ............................. ........f hone:.................... Plan Check Fee (loss deposit of$.......... Rct. #..........)$...................... 6 S. Contractor - ectrical: Energy Plan Check Fee (Dep. of $........ Ret. #........)$....................... City Business License p.................... Phone*''* V?507JZ StrongMotion Fee ..........................................................$.....................- Plumbing: ...................................................................................... Plumbing Permit Fee ................................................$....................... City Business License #.................... Phone:.................... Electrical Permit Fee ......................................................$....................... Heating and Cooling .................................................................. Mach. Htg./Cooig. Permit $ ..............................$.....-............... City Business License *................... Phone:.................... Construction Tax............ ................................$................... Architect/Designer: .................................................. Phone:.................... Sewer Conn. Fee .............. Water Conn. Fee ..............$....................... Engineer: .................................................... ............. Phon ...wnk......... Landscape Fee .................... Street Tree Fee ............$....................... Lender: ...........................................................-...................k .,.qpwn Misc. Fear.......................................................................$....................... ............ "I certify that in the performance of the work for which this permit Is issued I shelf not employ any pawn In any manner so as to become subject to the workman's compensation lam of California." Type Const......... Group........ Div.... ... Oce. Load........ No. Exits....:... SIGNATURE OF FloOfx Loads: tat.... 2nd.... Other.... Sprinklered.... Area Sep. Walls.... APPLICANT/OWNER ................................................................. DATE............................ I certify that as the applicant I am licensed under the jq Contractors Llcant.L;a d further that my License No Ein*v6n�;e�ta'I'Siatuif: Exempt............ Other........................................ in Classificatian .................. Is In full force and effect:or • Design Review Approval: Bldg. ............ Site ............ Sign ............ ............ I certify that am exempt from the"Licensed Red, ad" provisions of the Use Zone ........... P.D. Conditions ............................................................ Contractors License Law. (Slate bass of exemption., I hereby acknowledge that I have mad this application and state that the above Is Cond. Use i;�rmlt #.�-Variance #...... Parking Spaces.... Load.Sp..... correct and agree to comply with all City Ordinances and State Laws regulating AakovedBy........................................................... Date'........................... building. I (We) agree to save, indemnify and keep harmless the City of Cupertino • against liabilities, judment%n:,,oeJ:aandAxpenses which may In any way City In c 'n I of the granting of thisyermit occurs against said ... .... oachment Permit........................ Grant of Easement........................ SIGNATURE OF 110 Gutter, Sidewak, Driveway: Replace Repair APPLICANT/CONTRACTOR DATE L�10.4;K�hf. Sewer............ Conn. Fee $................ Water................ Meter$................ ry NOTE: When properly validated this tam consUbutes a Building Permit. This Agreement for Completion of Public Works Improvements .................. Permit expires and becomes null and sold should work nal be commended wM& Plans Checked By........ Date........ Approved By........ Date.................... 120 days from validation date, or should authorised construction be suspended or If, abandoned!for a period of 120 done after work to commenced.APPLICATION FOR ELECTRICAL PERMIT i� APPLICATION FOR PLUMBING PERMIT PERMIT INSTALLATION NO. EACH FEE Light Outlets............Switches............ PERMIT INSTALLATION NO. EACH I Vrr Fixtures............ Receptacles............ Gas Sytem with up to 5 outlets ................................... $4.00 ............. TOTAL NUMBER(less than 1000 watts) ................ $ .50 . .............. Each additional outlet ..........................................1 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 08 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/$40.0 .. ............................... ... ....... .......... Sewer ................................................................... ........1 8.00. .. MOTORS,Generators,We,01 , eaterli, I Lawn sprinkler Sys. $6.00 Ea. add Sys. $2.06Q.,:::::::: ................................ per HP-KW-KVA to 1/ 0 1 Vacuum Breakers .................................. 4:10.:::.......... 20/$6.6 5 10. 0, 1 0 Slop Sink........ Floor Sink........ Floor 6*��i� 4.00 .......... 500/$15-0 .. .. . ................................................ ............ ........... Urinal.... Interceptor.... Water Softener.. ............ 4.00 .......*'"*** Each Signa with .. I F ....................................................... 2.00 . ............ Plumbing Piping without fixtures ......... ............ 4.00 ............. d itional XFMR/Time Clock .. ................ .50 . .............. Misc. ......................................................... .........I...................I...... Annual Electrical Maintenance ................. 25.00 .. .............. Permit Fee ..........................................................................$ 6.00 war divan C U a d t TOTAL PLUMBING PERMIT FEE (plus penalty if app. E]) $_ . I ) k . ..... ............... ........... APPLICATION FOR HEATING/COOLING PERMIT .......................................................................... ........- I.......................... J? I Permit Fee ........................................................................ $ 6.00 PERMIT INSTALLATION NO. EACH FEE TOTAL ELECTRICAL PERMIT FEE (plus penalty if app.[:)) $ Forced Air Unit...............to 100M ................................. $ 6.00 .............. over700M.................... ........ 10.00 ............... Comfort Cooling Unit.....to 3 ton/HP............................ 6.00 ............... F a / Foundation............................... By:.................. Date:................ to 15 ton/HP......................... .. 9.50 ............... bing Ground Work ............................................................................ to 30 ton/HP..........................12.00 ............... hElectrical ........................................................................................ to 50 ton/HP.......................... 17.00 ............... a - Plumbing and Heating ............................................................. Space Heater........ Wall Heater ..................................... 6.00 ............... ation / Energy................................................................................. Z - other than above ................................................3.00 ............... $Test ............................................................................................... Vent an Kitchen........ Bath ................ 3 6:10 ........ Temporary Power Gas / Elect................ .1 00 :::: .............................................. Commercial Range Hood .................................. ........... Final - Electrical ..................................................................................... Misc. ........................................................................................................... Final - Building/Mechanical ...............I............................................... Permit Fee ........................................................................$ 6.00 Final - Design Review / Landscaping .1........................I........................... TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. 0) If Final - Public Works........................ ,1A,6-r-p covouir a "c,97zoA/ti...V;....In&.............. A" ,. -A« `1t7;17(J, ' -- 2t�� sl"yya