13301 POST THIS CARD NEAR FRONT OF BUILDING
" - PFRMIT NUMRER
CITY OF CUPERTINO 13301
INSPECTION DIVISION
JOB INSPECTION RECORD .
PERMIT EXPIRATION
JOB ADDRESS 10123 NORTH WOLFE ROAD UNIT# LOT#
-PERMIT EXPIRES IF WORK
OWNER Westfield Inc. CONTRACTOR Ray G. Hellwig IS NOT STARTED WITHIN I
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION /QO/ /°S'' ;w A/N< ANCE OR 180 DAYS'FROM
LIFER 'Jyd..P�,,[flpL f. 7F);Yl o LAST CALLED INSPECTION.
PREGUNITE 3pv StwgQ IUf StA / - PERMIT VALIDATION
ARBA SI-6?l�!/8
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 35D 1_T*to SW9
UNDERGROUND /'SLAB AICPA ?-//-njo
PLUMBINGps,® / +,
ELECTRICAL ear-
I ISSUANCE GATE
MECHANICAL �u�N e�7m-�c,: ELECT. PLO. MECH.
�t+uiOX Ad \�\r c, R LJ ❑ ❑• ❑.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 6-72,oeAfpM1,ys _ / / �`,\1, nLDIIRNAEIONNG RMIT
WOOD FLOOR (/N7ML A7�11eA Paas
VALUATION $/FT.
PLUMBING /a RA9 ewG¢J�/16FC_f oar
MECHANICAL 9-,W-foo
ELECTRICAL /DO/ -P1&jGR7•r PERMIT TO
FRAMING E,/DDF 7w.V"L A /JOLR
STORIES TYPE CONSTR.
INSULATION /0_ /�- 0/ �d •�2LF/ n9
-S ox AA
OCC,GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO,FL.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
RUILO USE
' HES IND CON
PR Olner
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ROUGH
ASSESSORS PARCEL NO.
� -
PLUMBING' -
GAS TEST TRACT NO. PARCEL NO.
MECHANICAL
AGC.DATE ACC.FILE NO.
ELECTRICAL FINALS DATE INSP. +-
FRAMING SAN # I
INSULATION ------
NSULATIONPLUMBING x°N'Nc ENG.SITE NO.
GAS
MECHANICAL FIRE$PRINK ENERGY LN
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ v ❑ ❑
LATH-INTERIOR - ELECTRICAL '
FLOOD ZONE A.L.U,C.
LATH-EXTERIOR FIRE DEPT. Y Co] "❑ Y ❑ No
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING -
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLSELECTRIC , PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. 'MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC
H� ONE WORKING.DAY BEFORE REQUIRED INSPECTION. PLUMBING c '
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z A• 'MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE 24 TOTAL
CALLING FOR FINAL INSPECTION. r
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING
APPLICATION & PERMIT
A°° 13301
ESa
10,
oolf
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNERS PLAN CHECK VALIDATION
. NA E QTY. ELECTRIC PERMIT FEE
NE
NONTHACTOR's UTLETS-SWITCHES-RECEP 10.0011.00
ND LIGHTING FIXTURES 10.00/1.00
CON °R' PPLIANCES-RESIDENTIAL 4.00
ADD
PNONE .( PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN LHECK FEE P.C.NO.
OR
ENGINEER
uc.No. SIGNS TRANS. 3.00
ARCH.
OR ENG. SPECIALCIRCUIT 5.00 PER MIT VALIDATION
SS
ZIP TEMP.METER OR POLE INS. 20.00
APPLIc^" MOTORS SEE FEE SCH.
ADD n
SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION /
< i W I hereby affirm that 1 am licensed under provisions of Chapter 9 _ ISSUANCE DATE
�` _ (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
O z u¢�i Jx, Professions Code,and my license is in lull forte and effect. ❑ ❑ ❑
2 o m License Class Lic,Number
Date Contractor
<y s BUILDING PERMIT
¢ ¢ a ¢ OWNER-BUILDER DECLARATION INFORMATION
D i< " MISC.- REFER TO ORD
x ;u y I hereby affirm that I em exempt from the Contractor's License VALUATION $/FT.
w I_O ¢ Law for the following reason,(See.7031.5,Business and Professions PERMIT ISSUANCE 10.00
L - Code:Anycilyorcounty which requiresa permit loconstruct,alter,
¢ a a Fo improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
w -O requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
w$u o he is lice Ised pursuant to the provisions of the Contractor's License rSL a
H 2> Law(Cha ter 9(commencin with Section 7000)of Division 3 oftlre o /�
i o Business and Professions Code)or that Ise is exempt therefrom and QTY. PLUMBING PERMIT FEE
te H$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicanito a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars($5001.):
❑ I,as owner of the properly or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sale compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions qvio DRAINS-FLOOR,ROOF,AREA,COND. 5.00 t
Cade:The Contractor's License Law 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 - BO.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.IL however,the building
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
❑ 1,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 Bfemon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with it contractor(s)licensed pursuant to SEW ER-SANITA -STORM EA.200ft/10.00
the Contractors License Law. * TRACT NO, PARCEL NO.
❑ l am exempt under Sec. ,B.&P.C.for this WATERH U /VENT 6.00
reason
Owner Date WATER SYSTEM Qi 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that l have a certificate of consent to self-insure. J4+` �1n ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy thereof(Sec 3800,Lab.C.). Q .
Policy No. Company
O ❑ Certi fed copy is hereby furnished. FIRE SPRINK ENERGY T 24
ZZ `IsY Ccrli c y is 01 d wi the 'ty insp lion division. MISC.- REFER TO ORD.
O 46cant Y❑ N❑ Y ❑ N[]= y CERTIFICATE OF EXEMPTION PROM WORKERS' PERMIT ISSUA CE 10.00 - FLOOD ZONE A.L.U.L.
LU > - COMPENSATION INSURANCE L TR. • ON LI NO. FLG. 7 Y❑ NE] V ❑ NC]a Q (This section need not he completed if the permit is for one TOTAL 0C
0 Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per. QTY. ECHANICAL PERMIT FEE FEE SUMMARY
LL I- mil is issued,I shall not employ any person in any manner so as 10
U become subject to the Workers'Compensation Laws of California.
0 y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex.
Z emplion,you should become 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 10,00011F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 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(See. 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 ELECTRIC
Lender's Address
• I certify that 1 have readthis 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-COMP(3 H.P.or 100,000 B.T.U.) 6.00
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.
(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
may in any way ace a agar! t said "ty in consequence of the PERMIT ISSUANCE 10.00
f this p mit. - MECH.CONT. LIQ NO. MECH.
TOTAL TOTAL
Sig Nre of Applicant/Contractor Date
OFFICE COPY