13548 (2) f:-:7 POST THIS CARD NEAR' FRONT OF BUILDING I ' ^^
CITY OF: PERM T HUMS
CUPERTINO 13548
INSPECTION DIVISION
JOB INSPECTION RECORD
�. r . • ' r - ' PERM IT•EXPI RATI ON
JOB ADDRESS lOFi31 STOKES AVE i� -UNIT# 'LOT tt 9
- - - PERMIT EXPIRES IF WORK'
OWNER BARRY BERGSTROM •CONTRACTOR .PAUL/WAliTERS BURNER INC IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTONREC RD �BODgvsoPPERNiITlssu-
FOUNDATION - 9 g' .• / �L 'ANCE OR.180 DAYS..FROM
UFER I ^i "" • - E ,d' TLATK.. _ �, LASTCALLED INSPECTION.
PEHMIT VALIDATION ' -
PREGUNITE �y�� `'
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED.' 1ti
UNDERGROUND/SLAB
PLUMBING
PA p
• ELECTRICAL' - , �LISSUANCE DATE r
MECHANICAL BLDG„ ELECT. PLG.
MFCH.
- - 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - -� ' gH}�DING PERMIT
WOOD FLOOR C�ty'0� elft, .,
I VALUATION - S/FT.
PLUMBING
MECHANICAL
P L
ELECTRICAL ..
�aMIT
. Wr�K -
FRAMING ' s
STORIES TYPE CONSTR.
INSULATION
OCC.GROUP,, -RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SG IT.FWOIIAREAj TOTAL ALRF.AGE
ROOF
DIAPHRAGM
BUILDING USE
I .� w' . 4 RES IND CONPB, Other
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED �D 9i ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
r 'TRAGI NO. PARCEL NO. ,
GAS TEST . ; •, a. . . . ... .. ,.
'.,'. MECHANICAL
- ELECTRICAL FINALS DATE INSP. Acc.DnTE -. . FRF ND.
FRAMING SAN # zoNING. ENG.SITE NO.
INSULATION •t' - ,PLUMBING -
, 'fit GAS ., .
MECHANICA FIRE SPRINK ENERGY T-24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED j HEATING, ❑ N❑ N❑
LATH—INTERIOR, ELECTRICAL . , 'PLooD eoNF A.LU.C.
LATH—EXTERIOR -. � FIRE DEPT: N Y'❑ N
SHEETROCK - GRADE-- FEE SUMMARY
.SHEARJNTERIOR BUILDING
�' • BUILDING
SHEAR EXTERIOR
TEMPO RARYAPPROVALS a
FIREWALLS ELECTRIC 4 PLAN CHECK'
FEET
- GAS .; L, ''
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY;; SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAUIS SIGNED BY BUILDING INSPECTOR. 'MICROFILM
•�,_, ELECTRIC
Lu ARRANGE F,OR INSPECTION.BY PHONING 252-4505;
Lu ONE WORKI NG,DAY-BEFORE REQUIRED INSPECTION PLu,MBING
PLEASE GIVE'JOB ADDRESS.WHEN PHONING s,;
+ ' Z = SEE PERMIT;FOR EXPIRATION DATE,.—' e A "MECHANIC--
- i iy��
IMPORTANT! cousr.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALL ING.FOR+FINAL INSPECTION.
- .OFFICE COPY.
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY .
BUILDING PROJECT IDENTI FICATION - PERMIT NUMBER
auILDAPPLICATION & PERMIT ^ p
AOORES I LE
oic ai S'� e. 6UILDtNG-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S . PLAN CH ECK VA LIDATION
NAME1 QTY. ELECTRIC PERMIT FEE j
PHON r✓Y1N1•I .
CONTRACTOR �NCs UTLETS-SWITCHES-RECEP ,10.00/1.00
N E
S L1(Je uc.'NO. LIGHTING FIXTURES , 10.00/1.00
r. NTRACTOR'S _s�' APPLIANCES-RESIDENTIAL 4.00
oDRESs, �1]1
NE �'�(� PANELS 10,00 DATE OF APPLICATION
' ARCHITECT - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ,
OR
ENGINEER 1 �.
LIC.No. SI GNS TRANS: 3.00
ARCH.OR ENG.-, SPECIAL'CIRCUIT• 5.00 PERMIT VALI DATION
ADDRESS
ZIP '. EMP,METER OR POLE INS. 20.00
ADDRESS rS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 7/l
woo LICENS 1;D CO NT'RACTORS DEC LA RA'r ION ff'
< v I hereby affirm that 1 am licensed under provisions of Chapter 9 :ISSJANCE DATE
y<N (commencing with Section 7000)of Division 3 of life Business and DE ECT. PLG. MECH.
F w¢ 1'rofessiore Code, my license is in full luratmlh144Mt I ❑ ❑
• z o,� .;cense Lic.Number JCJxI T 1 Yi _ O
O z r C/ sole-��Cnc.rmr r LDING PERMIT
¢ est , 01
M or w ¢
OWNER-BUILDER R-BUILDER DECLARA'T'ION INFORMATION
oA " MISC.- REFER TO ORD
K
3 LL N I hereby affirm that 1 am exempt from the Contractor's License VALUATION' S/FT.
F � vi Law for the following reusou.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE .10.00
Code:Any city or county which requires a permit m construct,alter,
¢ ¢Q 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. / �'
O¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT T
n w m u- he is licensed pursuant to the provisions of the Contractors License
Fri
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ H c the basis for the alleged exemption.Any violation m'Section 7031.5 STORIES TYPE CONSTR,
aim by any applicant for a permit subjects the applicant toacivilpenalty gLTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars($500)J:
❑ I,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 for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of r
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 so.FT.PLDDR AREA TOTALACREAGE
himself or through his own employees,provided that such improve-
marts are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 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 Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30,00
0 1,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec.7044,Rosiness LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who I LAWN SPRINKLERS-OVER 5(EA:) 1.00 ,
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. , TRACT NO. PARCEL NO.
O I am exempt under Sec. ,BAP.C.Isnthis WATER HEATER W/VENT 6.00 1
reason
Owner Data WATER SYSTEM ° 5.00 ACC.DATE ACC.FILE NO.
WORK F-RS'COMPENSA'TION DECLARATION ' WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate o(COnaent to belt-insnf0. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
.. copy thervlrfl'� Y;
o.Ln.c) �� FU v� t.?Q Policy NoompanyQ ❑ Ceheeby furnished. FIRE SPRINK ENERGY T 24
z Z �� liI II v'Ih [ 'y^+ilispeetion division.
n� plic:nll MISC.- REFER TO ORD. Y � N� v � 'N�
CC CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.C.
LL COMPENSATION INSURANCE PLG:CONTR. LIC.N0. - PLG. Y� N V N
CL O (This section need not be completed if the rattail is for one TOTAL
0 Z hundred dollars IS 100)or less.)
L) Q 1 certify that in the performance of the work.for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not employ any person in any mannerso as to
U become subject to the Worker%Compensation Laws of California. '�
0,a Duce Applicant ALTER OR ADD TO MECH. 5.00 BUILDING /7
}gym NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F ? emption,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=QF.1A) 4.00
'CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.FtM.) 6.00 SEISMIC FEE �$
s 1 hereby affirm that there is a construction lending agency I'or EXHAUST HOOD(WITH DUCT) 5.00
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 HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify,that I I.avc read this application and state that tlIc above VENTILATION FAN (SINGLE) 4.00
inform lion is correct. 1 agree to comply with all city and county. PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3H.P.or 100,000B.T.U:) 6.00
hereby authorize repmsentatives of this city-to enter upon the1
above mentioned property for inspection purposes. BOILER-COMPIOver 100,0008TU15EE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC. ' REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
ma m any way, aCfemc Sgamst 'd City in consequence of the 'PERMIT ISSUANCE 10.00
gr ntln isp mit MECH.CONT.' - LIC.NO. - MECH.
TOTAL TOTAL 0
Si ature ppli nt/Co me r Dat
OFFICECOPY