14045 f- POST THIS D NEAR. FRONT OF BUILDING ' •
PERMIT NUMBER
CITfOF CUPERTINO 14045
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
10101 N. WOLFE ROAD
JOB ADDRESS UNIT# LOT#
- PERMIT EXPIRES IF WORK
OWNER Westfield Inc. CONTRACTOR Westfield •• IS NOT STARTED WITHIN'
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMITISSU.
FOUNDATIONANCE G�p1 ,uG 180 DAYS FROM
Tamtf AOWWid3y LASTCAL LED INSPECTION.
UFER - JC 1o" Z4.4 IK
PREGUNITE T 'f - '
PERMIT VALIDATION
OK �jtS '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB - ' -
PLUMBING ' d.. 9��' SIIT lCc& 1-5-7-
pt:
ELECTRICAL r+' '
ISSUANCE DATE
MECHANICAL �1H.P Dc, ELECT. PLG, MECH.
G' is ' 17' ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED a,lkjzL SG Q9 UI OIRMATIONIT
WOOD FLOOR
PLUMBING ' VALUATION $/PT.
MECHANICAL
ELECTRICALPERMIT TO
' FRAMING J
INSULATION' STORIES TYPE CONSTR.
OCC.GROUP RES.UNITS
' PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO.FT FLOOR AREA TOTAL ACREAGE
DIAPHRAGMS
BUILDING USE
HES IND CON PB O,n ,
APPLY,NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 El ❑ D ❑
ROUGH ASSESSORS PARCEL NO.
PLUMBING
• GAS TEST - - TRACT NO. PARCEL NO. 'll
MECHANICAL
ELECTRICAL FINALS DATE INS P.
ACC.DATE ACC.FILE NO.
FRAMING SAN #
INSULATION PLUMBING ZONING ENG.SITE NO.
"
GAS
MECHANICAL FIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING E "� Y NF]
:
LATH-INTERIOR ELECTRICAL ' FLOOD ZONE AL.U.C.
LATH-EXTERIOR FIRE DEPT. Y❑ No Y 0 N�
SHEETROCK - GRADE FEE SUMMARY
' SHEAR INTERIOR BUILDING r
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING J
FIREWALLS . . ELECTRIC - . PLAN CHECK ,
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FI NAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM .
t ,` W
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ofO~� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN.PHONING.
44 - SEE PERMIT FOR EXPIRATION DATE _ MECHANICAL
IMPORTANTI, CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL " •r�a,e
CALLING FOR FINAL INSPECTION.
�. OFFICE COPY
APPLICANT TO FILL IN INFATION WITHIN RED LINES - USE U&LL POINT PEN ONLY
BUILDING PROJECT I DENTIFICi PERMIT NUMBER
pUI-1tlNG APPLICATION & PE, T-
ADI1FISss o �, - 14
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
- / OWNER'S / /- /PLAN CHECK VALIDATION
7` N E QTY. ELECTRIC PERMIT FEE /
PRONE - S�` p (/
ONTRACTO
NME UTLETS-SWITCHES-RECEP 10.00/1.00
Y p //(/(/ bW LIC.No. LIGHTING FIXTURES 10.00/1.00
CC.ONTRACTo �3 PPLIANCES-RESIDENTIAL 4.00 '
4 . PANELS 10.00 DATE OF APPLICATION
ARCHIT CT PLAN CHECK FEE P.C.NO,
OR PANELS (OVER 200 AMP) 20.00
ENGINEE �DO%/_
SIGNS TRANS. 3.00
ARCH.
NG SPECIALCIRCUIT 5.00 PERMIT VALIDATION
POLE INS. 20.
LG zIP O EMP.METER OR 00
APPLICANTS MOTORS SEE FEE SCH. -
ADO 54
SERVICECHANGE 20.00_ Y� /
Foo LICENSED CONTRACTORS DECLARATION p f/
¢u eRj 1 hereby affirm that I am licensed under provisions of Chapter 9 I�A,Di55UANCEDATE
Nw (commencing with Section 7000)of Division 3 of the Business and
¢n BLDG. E}�'��'G'1�J PLG. MECH.
H m i Professions Code,and my license is in full force and effect I_I I ❑ ❑
Di x G License Class Lic.Number -
M H j Date Contractor
PERMIT
OWNER-BUILDER DECLARATION VATION
w 3I- .I hereby affirm that am exempt from the Contractor's License MISC.- REFER TO ORD
m VALUATION $/FT.
I-
uo¢ Law for The following reason.(See. uires Business to
Professions . - PERMIT ISSUANCE 10.00
Code:Any city demolish,
or rep which structure permit m construct alter, �� `,a✓p�
auur ELEC.CONTR. LIC.NO. V (/t/ v
a¢,o improve,demolish,or repair any structure,prior n its issuance,also ELEC.
au C w requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
E:
$ he is licensed pursuant acing provisions of the Contractor's License
Fii Law(Chapler9(commencingwith Section 70001of Division Ef �/�/T�/Q.I� [-SMQ
S t c Business and Professions Code)or that he isexempt therefrom and QTY. PLUMBING PERMIT FEE
¢ r the basis for the alleged exemption.Any violation of Section 7031.5 STORIFIS TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars(S500)J: ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ 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 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 -
i property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SG.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such
improve-merits are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
1, or improvement is sold within one year of completion, the owner
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 - 'RES IND CON PB Omar
❑ 1,as owner of the property,am exclusively'contructing with ❑ ❑ ❑ ❑ ❑
licensed contractors to construes the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Lavi 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 contmcmns)licensed pursuant to SEWER-SANITARY-STORM EA.200fU10.00
the Contractor's License Law. TRACT NO, PARCEL NO.
❑ lam x mpt and e. ,HAP.0^F'or this WATER HEATER W/VENT 6.00
reason
Owner- ate WATER SYSTEM 5.00
• ACC.DATE ACC FILE NO.
woRK R OMP N A ION D V ARATION WATER TREATING EQUIP, 5.00
I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800;Lab.CJ.
Policy No. Company
O ❑ Certified copy ishcreby furnished. FIRE SPRINK ENERGY T24
Z Z ❑ Certified copy is fled with the city inspection division. MISC.- REFER TO ORD.
❑ N❑ Y ❑ N❑
'~ CERTIFICATE PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
COI -
W � OMPEIINSATION EXEMPTION FROM WORKERS'INSURANCE: _ PLG.CONTR. - LIC.NO. PLG.
Z (This section need not be completed if the permit is for one TOTAL Y❑ N[] Y C] N(_
hundred dollurs(S 100)or less.)
U O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
U, F mit is issued,I Shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws of California.
Q' +d+ Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 37o da -
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex.
F... ? emption,you should became subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
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 10=C.FM.) 6.00 SEISMIC FEE
I 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(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,Civ.C.),
Lender's Name HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify that I have read this application and stale that she 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-ODMP(3 H.P.or 100,000 B.T.U.) 6.00
's hereby authorize representatives of this city to enter upon the
( BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. ' MECHANICAL
above-mentioned property for inspection purposes.
I (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
I Cupertino against liabilities,ju ents, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any accrue again Ci y n consequence of she
gra fin o MECH.CONT. LIC.NO. MECH.
Ir TOTAL TOTAL - '�
Si nal eof p licant/C true r Dale✓
OFFICECOPY - -