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14169 (2) POST THIS CARD NEAR FRONT OF BUILDING PFRMIT NUMBER CITY OF CUPERTINO .14169 • INSPECTION DIVISION „.' JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS DRYCLEAN USA UNIT# _LOT# 20379 STEVENS CREK PERMIT EXPIRES IF WORK OWNER ENTRACTOR VALLEJO. PLUMBING IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTIONRECORD , 180DAYS OFPERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION ' LASTCALLEDINSPECTIOW LIFER _ PREGUNITE PERMIT VALIDATIo! POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED, UNDERGROUND /SLAB PLUMBING ELECTRICAL - ISSUANCE DATE MECHANICAL BLDG. ELECT. PLG. MECH. ❑,;.§ ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION VALUATION ` S/FT. PLUMBING MECHANICAL ELECTRICAL PERMIT TD FRAMING STORIES TYPE CONSTR. INSULATION - OCC.GROUP RES.UNITS, PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF ` ISO.FT FLOOR AREA TOTAL ACREAGE DIAPHRAGM - BUILDING USE NES IND CON I PB Other APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO, ROUGH PLUMBING GAS TEST - TRACT NO. PARCEL NO. - Z,r MECHANICAL - . ELECTRICAL FINALS - DATE INSP. ACCDATE ACC.FILE NO, FRAMING SAN # INSULATION PLUMBING ZONING ENG.SITE NO. _ Z,Y�- GAS MECHANICAL �(J FIRE SPRINK - ENERGY T Z< �" V ❑ N Y ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH-INTERIOR ELECTRICAL FLOODZONE A.L.U.C. LATH-EXTERIOR FIRE DEPT. I Y❑ No Y ❑ N❑ SHEETROCK GRADE FEESUMMARY SHEAR INTERIOR - BUILDING. - - Zl� SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING. FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM ELECTRIC r. :. LU ARRANGE FOR INSPECTION BY PHONING 252-4505, � I-� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 77 .y O Z PLEASE GIVE JOB ADDRESS WHEN.PHONING. '.r.. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL oe,4d IMPORTANT! - CONST.TAX y, 7 PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING.FOR FINAL INSPECTION. �r ,OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ELLII LD1 NG PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT AO^RGSS pp p1. 9 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL - 1 4 OWNER'S o�I177LL PLAN CHECK VALIDATION 3 N .y^ AME QTY. ELECTRIC PERMIT FEE N (..JI PRONy OME c NAMEroRs OUTLETS-SWITCHES-RECEP 10.00/1.00 ' I 1A Q. I LIGHTING FIXTURES 10.00/1.00 CFN`iFtACfORV I - f O7 APPLIANCES-RESIDENTIAL 4.00 AooREss nn f.4 S RONE �p PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEEP.C.NO. OR O ENGINEER..� LOC.No. SIGNS TRANS. 3.00 ADDRESS ENG. - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP EMP. METER OR POLE INS. 20.00 APPLICANT'S ADDRESS OTORS SEE FEE SCH. L3,1 it SERVICE CHANGE'IPe 20.00 ,u.( " ' /�,L-AI /s��-[❑'g`J w o o LICENSED CONTRACTORS DECLARATION .i S' r G•CD ��^/ a v Ri I hereby affirm that I am licensed under provisions of Chapter 9 J '7 ISSUANCE DATE (commencing with Section 7000)of Division 3 of the Business and - h a e. ,r.; JC."A MI - B OG. ELECT. PLG. MECH. H m z Professions Co n my is n Is in full for- e � 'Z o m- License Class Ic.Number r - x❑-..n 4b0 9 r ° Date A"rnnracmr_ _ _ .4 !. w ¢ Y a a OWNER-BUILDER DECLARAT 'V�!7 BUILDING PERMIT Go a U MISC.- REFER TO ORD INFORMATION K 3 u.y I hereby affirm that I am exempt from the Con ractor's License VALUATION S/FT. F LL 0< Law for the following reason.(See.7031.5,Bu$nessand Professions PERMIT ISSUANCE 10.00 Code:Any city orcounly which requires a permit to construct,alter, p Q ¢0 Improve,demolish,Or repair any structure,prior to Its Issuance,also ELEC.CONTR. LIC.NO. ELEC. a G u requires the applicant for such permit to file a signed statement that - TOTAL /-� PERMIT TO w m he is licensed pursuant m the provisions of the Contrnctoi s License rza Law.(Chapter 9(commencing with Section 7000)of Division 3 ofthe /it/�[C�•-/Oaf �M j r 4 0 Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE ¢R the basis for the alleged exemption.Any violation of Sect ion 7031.5 STORIES TYPE CONSTR. dI- by any applicant for a permit subjects the applicant to a civil penalty A LTER-DRAIN&VENT-WATER (EA.) 5.00 of not more then five hundred dollars($5000.): C? I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 (heir sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS intended cur offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:'rhe Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 $0.FT.FLOOR AREA TOTAL ACREAGE vI himself or through his own employees,provided that such improve- ments are not intended car offered for sale.If,however,the building or inhproventent is sold within one year of completion,the owner- builder will have the burden of proving that he did not huild or an. GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer ❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPR INKLERS- 1 INC5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ftI10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ I Ins exempt under Sec. ,BAP.C.I'm this WATER HEATER W/VENT 6.00 0 - reason Owacr Date WATER SYSTEMs 5:00 � nr ACG.DATE ACC.FILE N0. WORK B RS'COMPENSATION DECLARATION WATER TREATING EQUIP:'" 5.00 1 hereby affirm that I have a certificate of consent to self-insure, ZONING or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO. Copy thereof(Sec.3800,Lab.C.). Policy No. Company Q ❑ Certified copy is hereby famished. FIRE SPRINK ENERGY T-24 Z O `f/ Cert d py Is Jed with the It insltion division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑ Applican1L-O V N V N O: y CERTIFICATE OF EXEMPI'1 N FROM WORKI',RS' PERMIT ISSUANCE 10,00 s70 FLOOD ZONE A.L.U.C. UJ > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. CL Z( This section need not be completed it the permit is for one TOTAL a Y❑ N❑ Y❑ N❑ hundred dollar,($100)an less.) U 0 1 certify that in the performance of lite work far which this per' QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL I- mit is issued,I shall not employ any person in any manner so as to U become subject to the Workers'ComLIUpensation Laws of California. Q. Datc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING Z 3 } m NOTICE TO APPLICANT: If,after making Ibis Certificate GF,ix Z Sorption,you should become subject to the Workers'Compensation APPLIANCE - 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.11 4,00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=011FM.) 6.00 SEISMIC FEE 3, SU 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 I the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ C.), HEATING UNIT(TO 100,000 B.T:U.) 8.00 Lender's Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9,50 ELECTRIC QQ 1 Certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct.I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-OOMP(3 H.P.or100,000B.T.U.) 6.00 oe hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH 0, MECHANICAL 3�Pw above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and nxpeeses which CONST.TAX may in any way accrue,against said City in consequence of the PERMIT ISSUANCE 10.00 gmntl in, thispeuniy MECH.CONT. LIC.NO. MECH. TOTAL TOTAL Signature o'Applicant/Cont ctor Dute L OFFICECOPY