13434 (2) • POST THI RD NEAR FRONT OF BUILDING •
PFRMIT NUMBER
A, OF . CUPERTINO. 13434
INSPECTION DIVISION
JOB INSPECTION RECORD
10482 SCENIC CIRCLE PERMIT EXPIRATION
JOB ADDRESS UNIT# -LOT# PERMIT EXPIRES IF WORK
OWNER ALAN TANIGUCHI - coNrRAcroR SOUTH BAY- PLMB. Is NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
UFER LASTCALLED INSPECTION.
PERMIT VALIDATION
PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB r
PLUMBING 4
ELECTRICAL '" ISSUANCE DATE
MECHANICAL SLOG. ELECT. PLG. MECH.
❑ ❑ ❑: ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR ' INFORMATION
VALUATION $/FT.
PLUMBING -
MECHANICAL
PERMIT TO
• ELECTRICAL -
FRAMINGr
INSULATION 7CHIES TYPE CONSTR,
I OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF S0,FT,FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUILOI ON USE
R
" ES IND CON PB OVmr
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 1:1 ❑ ❑ ❑
ASSESSORS PARCEL NO,
ROUGH
PLUMBING ��V. '
TRACT NO. PARCEL NO,
GAS TEST
MECHANICAL '
ELECTRICAL FINALS DATE INSP. •ACC,DATE ACC.FILE NO,
FRAMING SAN 0
INSULATION PLUMBING
ZONING TING SITE NO.
' ��Q�
GAS
MECHANICAL FIRE SPRINK ENERGY T"24,
' -
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED , HEATING Y ❑ N❑ Y [D No
LATH-INTERIOR ELECTRICAL FLOOD ZONE A.L.U,C.
LATH-EXTERIOR FIRE DEPT. - Y❑ N� Y"0 'NE]
SHEETROCK GRADE FEESUMMARY
SHEAR INTERIOR . - BUILDING
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
1
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
L ONE WORKING DAY BEFORE REQUIRED INSPECTION.
• O~� PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
= SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT!
CONST.rnx
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. .
"OFFICECOPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - US5ALL POINT PEN ONLY
aDLLDING
BUILDING PROJECT I DENTI FI ON PERMIT NUMBER
APPLICATION & P MIT
E� �Z �tilC C1 13434
�(/ UI LDING—ELECTRICAL—PLUMBING—MECHANICAL
OWNER'a PLAN CHECK VALIDATION
""ME
L,gNE QTY. ELECTRIC PERMIT FEE -
� 7��l//��
"CONTRACTORUTLETS-SWITCHES-RECEP 10.00/1.00
//?`1 ,LIc.N°. 63 // LIGHTING FIXTURES 10.00/1.00
r-Ory
Acrons
APPLIANCES-RESIDENTIAL 4,00
A R AC
Sr C_PNONE Z PANELS 10.00 DATE OF APPLICATION
Rc"rtscr PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.N0.
O
OR
ENGINEER
' uc.NC. SIGNS TRANS. 3.00
ARCH.OR ENG. - SPECIAL CIRCUIT S.00 - PERMIT VALIDATION
AOORESS
ZIP TEMP.METER OR POLE INS. 20.00
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 7
woo LICENSED CONTRACTORS DECLARATION
¢ u I hereby affirm (bat I am licensed under provisions of Chapter 9 ISSUANCE DATE
w z e' (commencing with Section 7000)of Division 3 of the Business and
D" Professions Codec�amiL�toy license is in full force rryjdI f f BLDG. ELECT. PLG. MECH.
z o= License Class� _0—Lic.Numher�r° �� ❑ ❑ ❑
2 z H'w Data `Tr� Z G—Lf� Contractor -
a y 1 p BUILDING PERMIT
¢ ¢¢ OWNER-BUILD17R DECLARATION P�f INFORMATION
o d D MISC.— REFER TO ORD
E:
; n w I hereby affirm that I am exempt from the Contractor's License VALUATION S/FT.
H w• 0 Law for the following reason. 7031.5,Businessand Professions PERMIT ISSUANCE 10.00
— � Code:Any city or county which requires a permit to construct,alter,
rc ¢ improve,demolish,or repair any structure,prior 10 its issuance,also ELEC.CONTR. LIC.NO. ELEC.
u
requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
w$ he is licensed pursuant to the provisions of the Contractor's License
ea a r Law(Chapter 9(commencing with Section 7000)of Division 3 ofihe G•
¢ Business and Professions Code)or that he is exempt therefrom and CITY. a PLUMBING PERMIT FEE
W s¢. the basis for the alleged exemption.Any violation of Section 7031.5 ' STORIES TYPE CONSTR.
n by any applicant for a permit subjects the applicant to a civil penalty gLTER-DRAIN&VENT-WATER (EA.) 5.00 ,
of not more than five hundred dollars(S500)):
❑ 1,as owner of the property,or my employees with wages as BACK F LOW 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
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments.,a 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-EASYSTEM-OVER 4 (EA.) 200 BUILDING USE
builder will have the burden of proving that he did not build or am- . . .
RES IND CON PB .Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
❑ I,as owner of the property,am 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 an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SAN ITARY-STORME Q:2boft/10.00 TRACT NO, PARCEL NO.
❑ lam exempt under Sec.—,BAP.C.for this WATER HEATER W/VENT6.00
reason e^t%
Owner Date WATER SYSTEM V 1J5.00'
111 ACL.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING BQUIP. f 0
I hereby affirm that I have a certificate of consent to setrmsere, Ills ZONING
or a certificate of Workers'Compensation Insurance,or a certified Oi1N ENG.SITE NO.
copy there f S c,3800,Lab.C). r
Policy No�Company )'fAT1h s D
O Q Cer IB cop is hereby furnished FIRE SPRINK ENERGY T24
Z Z 1� Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
O APPlicant Y ❑ N❑ Y ❑ N❑
CC = CER1'IFICATEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 a — FLOODZONE A.L.U.C.
W > COMPENSATION INSURANCE PLG.CDNTR. LIC.NO. PLG,
M O (This section Reed riot be'completed if the permit is for one TOTAL 5 Y❑ N❑ Y ❑ N❑
D Z hundred dollurs(5100)°r less) -
V O I certify that in the performance of the work for which this per- CITY MECHANICAL PERMIT. FEE FEE SUMMARY
IL F mil is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
i Date ApplicantALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE TO APPLICANT: If,after making this Certificate of Ex.
? 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
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT ITO 10=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10=C.RM.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(See. MICROFILM
3097,Civ.C). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name H EATING UN IT(OVER 100,000 B.T.U.)9.50
Lender's Address - ELECTRIC
• Icertify that l have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING S
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP IOver 100.000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes:
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
r Cupertino against liabilities,judgments, casts and expenses which CONST.TAX
may in any way accrue against said City in consequ nce of the PERMIT'ISSUANCE 10.00
grantin this permit. MECH.CONT. LIQ NO. MECH.
7 Z q y zTOTAL TOTAL
Signe uof Applicant/Con for to
OFFICE COPY '