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13377 (2) POST. THIS CARD NEAR FRONT OF, BUILDING IENMITNUMBER T. CIY. OF CUPERTINO 13377, INSPECTION DIVISION "JOB.INSPECTION RECORD - PERMIT EXPIRATION 10631 ' STOKES JOB A'DDR ESS UNIT# LOT 4t r . : PERMIT•EXPIRESIF WORK '{ BARRY BERGSTROM ' "PAUL 'WALTOS-BLDR. IS NOT STARTED WITHIN OWNER CONTRACTOR INSPECTION DATE INSPECTOR INSPECT ON RECORD - 18O.DAYS of PERMIT Issu ANCE OR 180+DAYS FROM'. '. FOUNDATION"+ %� ' ��Y 'L'AST CALLED INSPECTION. .. UFER' :r/.4cT'Y�k /j4L�ry7JG - PERMIT VALIDATION PR EGUN ITE. - PAT POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB qe C j PLUMBING' ST r ELECTRICAL. '` I DATE MECHANICAL .I D ELECT. PLG. MEECCH. Eli, El DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT . .WOOD-FLOOR '• INFORMATION • + VALUATION;'• $IFT. PLUMBING . ..,, I •k•+ MECHANICAL : r , PERMIT TO ELECTRICAL FRAMING - '" I - INSULATIONs DRI s T EcoNSTR. . S - DCO.GROUP�. RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED K '� .ROOF { r SD FT FLOON AREA iDTAC A6REAGE �\ DIAPHRAGM. BUILDING USE HES ,IND "CON PB Olnm APPLY.NO ROOFING UNTIL ABOVE HAS.BEEN SIGNED El El- `� �` _ nssessDRs,vAl+ceL No. " ROUGH „ PLUMBING - GAS TEST - - - - TRACT NO. PARCEL NO. 1 .1 MECHANICAL - - ACC.DATE ACG FILE NO. ELECTRICAL FINALS DATE INSP. FRAMING.- ',y r -�a ' ,J - SAN #.• - o'• - ZONING INSULATION' - PLUMBING ' - ' ENG:SITE NO. .. GAS: - MECHANICAL: FIRE SPRINK ENERGY)24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y El N[:] [:] ND LATH-INTERIOR - ELECTRICAL • .FLooD zorvE A.L.u,c. LATH—EXTERIOR - FIRE DEPT. - 'i :,�, , v Yo "F SHEETROCK' - GRADE' "; FEESUMMARY SHEARINTERIOR 'BUILDING SHEAR EXTERIOR` ' ` TEMPORARY:APP.ROVAL•S BUILDING A;C , I ✓ ` _ ' FIREWALLS ELECTRIC PLAN CHECK ` GAS .. 'FEE' .� NO TAPE OR PLASTER,UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT,PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR, INSPECTION BY PHONING 2524505 ELECTRIC o� ONE'WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING :T. PLEASE GIVE JOB ADDRESS WHEN,PHONING, Sl� Z _ ='SEE PERMIT FOR EXPIRATION DATE -, MECHANICAL '• _ x- > CONST.TAX IMPORTANT.; ' �IPLEASE READ REVERSE SIDE BEFORE � � •'' � r �', ..TOTAL' f CALLING FOR FINAL INSPECTION. OFFICE COPY • ' APPLICANT.TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY -' BUiL61NG PROJECT I DENTIFICATI ON PERMIT NUMBER BUILDING APPLICATION & PERMIT r ADDRESS l 0631 (-1�b; ,� 133 7 7 \J BUILDING-ELECTRICAL-PLUMBING-MECHANICAL ' OWNER'S - - PLAN CHECK VALIDATION LOE I G QTY. ELECTRIC PERMIT FEE M'I� l' Wim- PHONE �E/ � Z. - NTRACTO 'S /^ •F t </ OUTLETS-SWITCHES-RECEP; 10.00/1.00 E .. ' + a WRI - cper LID NG, `f ' a LIGHTING FIXTURES 10,00/1.00 : CONTRACTOR'S S: APPLIANCES-RESIDENTIAL' t 4:00 AODHEs''J('j� / p Q Z [,b Wt�` 9��f/L,PROrvE � 0 PANELS 10.00 DATE K APPLICATION ARCHITECT - - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.N0. OR • ENGINEER - ' uc.NO. SIGNS TRANS. 3.00 ARCH.OR ENG. SPECIAL CIRCUIT SOO PERMIT VALIDATION ADDRESS . ZIP TEMP.METER OR POLE INS. 20.00 P,Q APPLICANTS + MOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE " 20.00 rf'^,`1�•1 I .-WDECLARATION �o o LICENSED CONTRACTORDECLARATION ¢u "1 hereby affirm that I am licensed underprtmisidns of Chapter 9 L r 1NCE DATE y a H (commencing with Section 7000)of Division 3 of the Business and - - , O. ELECT. PLG. MECH. Professions Code,am,112y license is in full force CG'eC, d z o n License Class Lic.Number `A`I f O ❑ '❑ ❑' 9 - Contractor F o r j Date ¢ m s _ BUILDING PERMIT ¢ ¢ w OWNER-BUILDER DECLARATION t INFORMATION X o'A I hereby affirm that I am exempt from the Contractor's License MISC.- - REFER TO ORD 3 u,A ' VALUATION $/FT. ao¢ Law far the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 ENa� Code:Any City or county which requires a permit to construct,alter, - p ¢ ¢¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. c 0 81 0 o¢ requires lire applicant for such permit to file u signed statement that TOTAL PERMIT TO wm he is licensed pursuant to tine provisions of the Contractor's License ' Law Chapter 9(commencing with Section 7000)of Division3 ofthe p 116-h "C Q%�«l ¢ Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT =FEE the basis for the alleged exemption.Any violation of Section 7031.5 tTORIES TYPE CONSTR. u by any applicant for a permit subjects the applicant to a civil penalty of natmore than five hundred dollars($500f): ALTER-DRAIN&VENT-WATER'(EA.) 5.00 r ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS' their sole compensation,will do the work,and the structure is not - - _ intended or offered fon sale (Sec. 7044, Business and Professions- DRAINS-FLOOR,ROOF,AR EA,COND.- 5.00 - Code:The Contractor's License I.aw does not apply to an owner of - property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE .himself'or through his own employees,provided that such improve- meits are not intended or offered for sale.If.however,tine building GAS-EA.SYSTEM-.11NC.40UTLETS 6.00 or improvement Is sold within one year of completion,the owner, GAS-EA.SYSTEM:OVER 4 (EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- RES IND CON PB Omer prove for purpose of sale,). INDUSTRIAL I A L W ASTE INTER. 30.00 ❑ 1,as owner of the property,um exclusively contracting with .❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project (Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to in owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 : contracts for such projects with a contractons)licensed pursuant to - SEWER-SANITARY-STORM EA.200ft/10.00 the Contractors License Law. 'TRACTNO. PARCELNO. ❑ tato exempt under Sec. ' - ,Il.&I'.C.for this WATER HEATER W/VENT' 6.00 --� reason �" ' Owner Dam WATER SYSTEM„ 5.00 - ACC.DATE ACC.FILE No. WORKERS:COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificateOf consent to self-insure. - v ZONING ENG.SITE N0. or a certificate of Workers'Compen lion Insure e,or certified sq copy dmrc Se 00,Lab.C.). .f-.,f - Policy No. Compan 1-r Q ❑ Certified copy is hereb f (shed. FIRE SPRINK ENERGY T 24 Z Z ❑ CertifiI copy ed th the city inspection division. MISC.- REFER TO ORD. 0 App111111 v❑ N❑ Y ❑ N❑ ~ a PERMIT ISSUANCE- 10.00 FLOOD ZONE A.L.U.C. LIJ CERTIFICATE E EXEMPTION FROM WORKERS .. CL - COMPENSATION INSURANCE PLG.cONTR. LIC.NO. PLG, e' CL 0 ('Phis section need not be completed if the perinit is for one " TOTAL Y❑ N❑ Y❑ N❑, D Z hundred dollars($100)or Ico.) U 0 I certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE - FEE SUMMARY LL F- n.it is issued,I shall not employ any person in any munnerso as to U become subject to tine Warkers'Compensation Laws of California. Ow Date APPlicant BUILDING - � -� C. ALTER OR ADD TO MECH. 5.00 } m NOTICE 'I'O APPLICANT: If,ifteLmeking this Certificate of Ex- '-' - Z emption,you should become subject to the Workers Compensation APPLIANCE t 5.00 PLAN CHECK j/ 3 7 provisions of the Labor Code, you must forthwith comply.will FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 ' CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE S7J I herebyaffirmthat there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lenders Address ELECTRIC ®t . 1 Certify that I have read this application and state that the above ,VENTILATION FAN (SINGLE)- 4.00 information is correct. I agree to comply with all city and county- PLUMBING ordinances,and state laws relating to building construction, and BOILER-COMPI3 H.P.of 100,0008.T.U.) 6.00 hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes.: BOILER-COMP (Over 100,000 BTU)SEE FEE$CH. MECHANICAL I (We) agree to save, indemnify and keep harmless'the City of, - MISC.- REFER TO ORD. Cupertino against I' "ties,judgments, costs and expenses which PERMIT ISSUANCE - 10.00 - - CONST.TAX may in any way c e..against said City in consequence of the grunting i5 pe MECH.CONT. LIC.NO. MECH. ,q 2312--tTOTAL TOTAL �J J 7 'ignature Df Applicant/Con actor DntI / OFFICE COPY