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12693 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE RAIL POINT PEN ONLY AMC ,*BUILDING PROJECT IDENTIFICII PERMIT NUMBER BUILDING APPLICATION & PEWT AOOn Ess O ";; �4 ����•�� -D BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 1 • 693 OWNER'S PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE I/ CONTRACTORSOUTLETS-SWITCHES-RECEP 10.00/1.00 NAME lKC• LC.NO. LIGHTING FIXTURES 10.00/1.00 r r-ONTRACTORtce/ 4ucteu. Z1� PPLIANCES-RESIDENTIAL 4.00 ADDRESS ,1 r. ` �Q y1 �Ly�N NE� �I PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. OR ENGINEER Llc.no. SIGNS TRANS. 3.00 ARCH.ORENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ADDRESS PACU ZIP EMP. METER OR POLE INS. 20.00 !!''���� APPLICANTS MOTORS SEE FEE SCH. *87 ADDRESS pPR 2 3 SERVICE CHANGE 20.00 wo D LICENSED CONTRACTORS DECLARATION ��EE�,�yE� ¢u I hereby affirm that I an licensed under provisions of Chap[er 9 f�4tJk�E DATE H Z L, (commencing with Section 7000)of Division 3 Of the Business and BLDG. ELECT. PLG. MECH. H N V, Professions Code,and my license is in full force and effect ❑ ❑ ❑ i o M - License Class Lic.Number 2 v, La Date Contractor tc a,w¢ OWNER-BUILDER DECLARATION BUILDING PERMIT 0 a " - MISC.- REFER TO ORD INFORMATION w ;LL H 1 hereby affirm that I am exempt from the Contractor's License VALUATION $/FT. F .. O J Law for the following reason.(Sec.7031.5.Businessland Professions PERMIT ISSUANCE 10.00 Cade:Any city or county whichrequnc,ii permit to construct,alter, 2 6 s-Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. ✓1 la - O u requires the applicant I'or such permit to file a signed statement that TOTAL PERM. TO u w w he is licensed pursuant to the provisions of the Contractor's License Hzi Law(Chapter 9(commenciagwith Section 7000)of Division3 ofthC ¢ Business and Professions Code)or that he is exnnpt therefrom and QTY. PLUMBING PERMIT FEE 2 r$ the basis for the alleged exemption.Any violation of Section 7031.5 rSQT. OR s TV PE CONSTR. w. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.15.00 Of not more than five hundred dollar,(5500).): ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 RO S.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 docs not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 FLOOR AREA TOTAL ACREAGE himself or through his awn employees.provided that such improve- GAS-EA.SVSTEM-11NC.40UTLETS 6.00 ments are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 IEA.) 2.00 BUILDING USE builder will have the burden Of proving that he did mol buil)or im" . RES IND CON Pe Omar prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 1,as owner ol'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 Codc:The Contractor's License Law does not apply to an owner of properly who builds or improves Hereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contructons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACTNO. PARCEL NO. the Contractor's License Law. ❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 WCC.DATE FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to sclHosure, ZONING ENG.SITE NO. ora certificate Of Workers'Compensation Insurance,or a certified copy thereof(Sce.3900,LA C.). Policy No. C r any O9�E he by fU aSIT' FIRE SPRINK ENERGY T34 Z_ Z is tied wit, ra 'ty inspection division. MISC.- REF ER TO ORD. y ❑ N.❑ Y ❑ NPERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. mOp li%IiMPTION FROM WORKIiRS'lL PENSATION INSURANCE PLG.CONTR, LIC.NO. PLG. Y❑ N❑ Y IDN❑ d Q (This section need not be Completed i1' the permit i, for one TOTAL Z hundred dollms(SI00)or loss.) U Q 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL I- mit is issued,I shall not employ any person in any nannerso as t0 Wbecome subject to the Workers'Compensation Laws Of California. BUILDING Dade Applicam ALTER OR ADD TO MECH. 5.00 Q.O } DO NOTICI7 TO APPLWAN'I': If,after naking this Certificate of ISx- H 2 emotion,YOU should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you most forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO lOPWC.F.M.) 4.00 coNSTRUC'noN LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 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 lot which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,Cie.C.). Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 informmion is correct. 1 agree to comply with all City and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and slate laws relating to building consvuc,Le and hereby aulhorim representatives of this city II ewer upon the 130 LE R-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purpaxs. / We, agree to save, indemnify and keep harmless the City of MISC,- REFER TO ORD. / Cupertioginbililies,judgments, cos"and expenses which CONST.TAX may intrueago' st said City in consequence of thePERMIT ISSUANCE 10.00grantin 't. MECH.CONT. LIC.NO. MECH. Z TOTAL TOTAL Signature of Applicant/C< 7 Date OFFICECOPY \ - POST THIS O NEAR FRONT OF BUILDING • 1`1'11M111 f NUN13E li CITY OF CUPERTINO 12693 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS „- ' UNIT#_ -LOT# PERMIT EXPIRES IF WORK E r coNTRACTOR IS NOT STARTED WITHIN SPECTI DATE. INSPECTOR INSPE TION RECORD '.' 180 DAYS OF PERMIT ISSU- ON / /- c�-�' ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. PER ECONCRETE UNTIL ABOVE HAS BEEN SIGNED APR Gi 3 X957 UNDERGROUND /SLAB City wt/��� fi ft PLUMBING G.7 V, �Yp�uEV ELECTRICAL ISSUANCE DATE G. ELECT. PLG. MECH. MECHANICAL ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION . WOOD FLOOR VALUATION $IFT. PLUMBING MECHANICAL PH N T TO ELECTRICAL /1 FRAMING STORMS iv F UNSi H. INSULATION ' OCC.GROUP RES.UNITS • PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF U.ii.FLOOR AREA TOTAL A IIEALE � �• DIAPHRAGM BUILDING USE HES IND N PB Olney Cl El APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED _ EL ASS[SS SPARCEL NO. i ROUGH PLUMBING TRACT NO. PARCEL N0, GAS TEST MECHANICAL .,..'' ACC.DATE ACC.FILE No, ELECTRICAL FINALS, ., r o�DATE�.1. ,;`INSP.F:. FRAMING SAN # ZONING ENG.SITE NO. INSULATION PLUMBING / / - / GAS FIRE$PRINK ENERGY T 7< MECHANICAL ,COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED `. HEATING Y OO N❑ Y ❑ N❑ FLOOD ZONE A.L.U.L. LATH-INTERIOR ELECTRICAL LATH-EXTERIOR FIRE DEPT. Q 25 8D V_ r N� v I] N❑ SHEETROCK GRADE ri'-ri ..I FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, CONST.TAX ELECTRIC • "' ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 0� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL — SEE PERMIT FOR EXPIRATION DATE — IMPORTANT! PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. POST THIS C D NEAR FRONT OF BUILDING CITTOF CUPERTINO - HM1IITNDM119fiR s (� INSPECTION DIVISION 12,693 JOB INSPECTION RECORD PERMIT EXPIRATION ' JOB ADDRESS 10123 N Wolfe Rd. UNIT# LOT# PERMIT EXPIRES IF WORK OWNER Westfield In CONTRACTOR Westfield Inc. IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATIONSd _7QM 0..lfp /n'TSlA ANCE OR 180 DAYS FR a GK UFER LASTCALLED INSPECTION. PREGUNITE �I f61 PER#VALIDATION win POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED /!7- -fjr( /�/ ���L'^'L i 1bS APR 2 $ 1987 UNDERGROUND /SLAB t-WKS- PLUMBING / 7ptAl .&o Of/JM..u__ ELECTRICAL - ISSUAN MECHANICAL //-/(,. .07O ' J /NS Lo ELECT. PLG. MECH. FIA14Led iKA El ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUI DING PERMIT INFORMATION WOOD FLOOR VAWATION SBFT. PLUMBING �1 - MECHANICAL Opp PERMIT 11 ELECTRICAL ,^': FRAMING YL STORIES kk PE CONSTR. INSULATION r .,{/ / r OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 50.FT.FLOOR AREA TOTAL ACREAGE ROOF DIAPHRAGM BUILDING use Res IND CON Pe ow.. El El 11 El CD APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ASSESSORS PARCEL.NO. ROUGH PLUMBING TRACT NO. PARCEL NO GAS TEST MECHANICAL ACC.DATE ACC.FILE NO. ELECTRICAL FINALS DATE INSP. FRAMING SAN # 05 ZONING ENG,SITE NO. INSULATION - PLUMBING 14-0-7 GAS FIRE SPRINK ENERGY T24 MECHANICAL Y N� Y ❑ N� COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOODZONE A.L.U.c. LATH-INTERIOR ELECTRICAL LATH-EXTERIOR FIRE DEPT. v Y ❑ N❑ ES SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING -! SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC ] SF'tO PLAN CHECK -1 F GAS EE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM � ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 1 • F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 0� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL — SEE PERMIT FOR EXPIRATION DATE — CONST.TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE TOTAL //- CALLING FOR FINAL INSPECTION. OFFICE COPY r CITY OF CUPERTINO �p►Q � CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE �...... o' . Building Permit No. . Date .......... At ..1-.41. 19.fJk I The Building Located at"_ �� - I ' (Owned by -------- . t � Completed or Use As: ....... ... .. ..s� ►t-(-l..L11L ........... ............ „ . .y 14J Been ered) / .................................................... ... ................................. PD-7 BUILDING INSPECTOR - I -- -- - - I� -