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1141 PERMIT NUMBER FOR APPLICANT TO FILL IN STREET ADDRESS OF PROJECT: DoZ EPARTMENT USE ONLY S-rc-I/ L-,v ....................-..........r ........I........................... ............................. Plans Received By....................................................Date ......................... Legal Description, Tract Block L gJ. ........ Tract.. ...... ............r 0 REQ.: Plans.... Survey.... Calcs: Strut..... Energy.... Elect..... Mach..... Description of Work: Je4tF. - . ...��/ Plans Checked By....................... Date Tat Struct. Improvement on Parcel:Yes.... No....Area of Bldg............... Application Approved By..........4..*4................ Date Separate Structure............ or Addition/Alteration to Exist. Bldg........... ValidatedBy..............................................................Date ......................... No. of Stories................ Use of liding ................................................ Compensation Certificate Verified By.................... Date ......................... Valuation of Project: D...!-40 p..:............................................... IOwner: .......................--............................................ Phone:.................... Permit Fee (plus penalty If applicable) Contractor: ........................................ City Bus.Lic. 0................................ Plan Check Fee (less deposit of$.......... ... ..............ZZ---- ----- Address: .....................................................................: Phone:.................... Rct. .....d. Contractor - Electrical: .............................................................................. Energy Plan Check Fee (0bp. of,$ Rct. #........)$....................... City Business License e.................... Phone:.................... StrongMotion Fee . ............................. ....................5....................... Plumbing: ..................................................................................... Plumbing Permit FeeJ.bt... .................$....................... City Business License «.................... Phone:............... Electrical Permit Fee ..................... y", . .....................$..................... Heatin I g and Cooling ..................................... ...................... Mach. HID./Coo1g. Permit $ ........... .............$....................... City Business License #.................... Phone:.................... Construction Tax.......... I...................................$....................... Architect/Designer: ............................................... Phone:.................... Sewer Conn. Fee .............. Wat�r Bono Fee ..............$....................... Engineer: ....................-............................:................. Phone:.......... Landscape Fee .......... ...... d Fee ........... 0-W .. Street Tre .$---- V-�Rw Lender: .................. E]....!.TR?T Misc. Fee ........................................................................$....&............... ............ "I certify that in the performance of the work for which this permit Is 00100000TRIff TINT.N. $ 7 Issued I shall not employ any person In any manner so as to become subled to the workmen's compensation Is"of California." Type Const......... Group........ Div......... Occ. Load........ No. Exits........ SIGNATURE OF Floor Loads: tat.... 2nd.... Other.... Sprinklered.... Area Sep. Walls.... APPLICANT/OWNER .................................................................. DATE........................... ZONING REQUIREMENTS ............ 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 affect: or Design Review Approval: Bldg. ............ Site ............ Sign ....... ...... I certify that I am exempt from the "Licensed Req. ad" provislons of the Contractors License Law. (State basis of exemption., Use Zone ............ P.D. Conditions ....................................................... I hereby acknowledge that I have mad this application and state that the above Is Cond.Use Permit i--,-,.Variance e...... Parking Spaces.... Load.Sp..... correct and agree to comply with all City OrdinancaB and State Laws regulating rovedBy........................................................... Date ........................... 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 secure against said City in consequence of the granting of this permit. O achment Permit........................ Grant of Easement........................ SIGNATURE OF VGutter, Sidewalk, Driveway: Replace Repair APPLICANT/CONTRACTOR ....................................................... DATE......................... Sewer............ Conn. Fee $................ Water................ Meter $................ NOTE: When properly validated this tons constibiles, a Building Parmill. This Agreement for Completion of Public Works Improvements .................. Permit expires and becomes null and void should work not be commenead tslUtln Plans Checked By........ Date...:.... Approved By........ Date.................... 120 days from validation date,or should authorized Construction be suspended a abandoned for a period of 120 days after mrk Is comehismard. APPLICATION FOR ELECTRICAL PERMIT APPLICATION FOR PLUMBING PERMIT 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).... ................ $ .5o ............ Each additional outlet ............................................ 1.00 ............. Range........ Cooking Unit........ Oven........... ................. 2.00 ............... Water System (Installation, Aft. 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' ............. too 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 aye. $2.00.................................... per HP-KW-KVA to 1/$2.00, 6/$3.50, Vacuum Breakers ............................................ 1 • 20/$6.50, 50/$10.00, 100/$12.00, Slop Sink........ Floor Sink........ Floor ::: 1100 ........... 500/$15.00 ................................................. ......... ................ . ........ Urinal.... Interceptor.... Water Softener.... ..........I............ 4.00 ............ Signs with I XFMR ...................................... 2 00 ..... Plumbing Piping without fixtures ...................... 4.00 ............. Each additional XFMR/Time Clock Misc. ....................................................................... ..............L............. Annual Electrical Maintenance Permit Fee ..........................................................................$ 6.00 Other (see Ordinance Current) .................. TOTAL PLUMBING PERMIT FEE (plus penalty it app. E]) III ......................................................................... ET* I APPLICATION FOR HEATING/COOLING PERMIT Permit Fee ........................................................................ $ 6.00 PERMIT INSTALLATION NO. EACH FEE TOTAL ELECTRICAL PERMIT FEE(plus penalty If app.(:]) $ Forced Air Unit...............to I DOM ........................ ......... $6.00 ............... over 100M .................... ........ 10.00 ............... Comfort Cooling Unit.....to 3 ton/HP............................ 6.00 ............... Forms / Foundation............................... By:.................. Date:................ to 15 ton/HP.......................... 9.50 ............... bg un -:...... ............................... ........ to 30 ton/HP..........................12.00 ............... h"'Elle�ctro,icald..Wo.r.'--::::::::�::::�:: *­ "*"'***.................**'*'*...*"**'*' to 50 ton/HP.......................... 17-00 ............... a - Plumbing and Heating .............................................................. Space Heater........ Wall Heater ..................................... 6.00 ............... ation / Energy............................... .................................................... Flues - other than above ..........4.....................................3.00 ............... Test .................................................................................*.......­....*­ Vent Fan: Kitchen........ Bath ..........................................3.00 ............... Temporary Power Gas /Elect............................................................... Commercial Range Hood .................................. 6.00 ............... Final . Electrical . I sc. .......................................................................I.................................... Final - Building/ Permit Fee ......................................................................$ 6.00 Final - Design Review Landscaping .................................................... TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. 0) /Mechanical ... ic ... Mi Final - Public Works...........................................................