NO PERMIT NUMBER 21898 Shattuck Drive
NO. STREET - LOT NO.
CITY OF CUPERTINO
APPLICATION FOR BUILDING PERMIT
SANITARY NO.
FILE NO.
DATEDe�. 1 8 19 78
Application is hereby made for a permit to
i nctall a story,type
to be occupied only as f i rPnl ara
in accordance with plot plan,plans and specification filed herewith.
ESTIMATED VALUE OF IMPROVEMENTS$ T.nn nn
FEE$_ 15-nn PLAN CHECK$ n
OWNER Mark Cj n}Pk ADDRESS 91 89A Rh attnrk T)r.
PHONE 255-8707
CONTR. ADDRESS
PHONE STATE LICENSE
APPROVED
BUILDING INSPECTION RECORD
DATE INSPECTOR DATE INSPECTOR
FOUNDATION FLOOR STEEL
PRE-GUNITE - FRAME
BOND BEAMS LATH
WALLBOARDS-INT.8 EXT.
FIREWALLS
MEMBRANE LANDSCAPING
F.M.O.INSPECTION
FINAL BLDG.
UNDER-FLOOR '
TIEDOWNS -MISC-
DIAPHRAMS
MOORE BUSINESS FORMS INC.,L/.
ELECTRICAL INSPECTION RECORD
RESIDENTIAL DATE INSPECTOR COMMERCIAL DATE INSPECTOR
UNDERGROUND ROUGHUNDERGROUND ROUGH
ROUGH WIRING 7 ROUGH WIRING
FINISH WIRING FINISH WIRING
FIXTURES INTERIOR FIXTURES
MOTORS EXTERIOR FIXTURES
FINAL MOTORS
FINAL
MISCELLANEOUS INSPECTIONS
PLUMBING INSPECTION RECORD HEATING&A/C INSPECTION RECORD
DATE INSPECTOR DATE INSPECTOR
BACK FLOW REQUIRED UNDERFLOOR S.M.
BACK FLOW INSTALLED DUCTS&INSULATION
UNDERGROUND ROUGH FLUES&COMB.AIR
PARTIAL ROUGH CONDENSATE DRAINS
ROUGH COMPLETE FINAL APPLIANCE
ROOF DRAIN&LEADERS
MAIN DRAIN
FINAL GAS
FINAL PLUMBING
MISCELLANEOUS
21
NO `KIK A d! LOT NO.
NO T �, _STREET
CITY OF CUPERTINO ..
FL- G' i�APPLICATION FOR PLUMBING PERMIT
3 1/ -�'" Q Sanitary No.
Date �! ! 19Permit No.
Fee$�O^p_ --
Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes and/or fixtures listed on the reverse side hereof, and agrees to install said pipes
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Work To Be
Premises Pufarmed
�^ ,'Owner M� �� W• Ci os'EkAddresspaTy
ID
Phone 259-9-101
By Address
Contractor,Agent
Phone /�
State Crr�.a� f -T 'r APProved
Plumbing Inspector
�r I AGREE I WILL NOT VIOLATE ANY OF THE WORKMEN'S
COMPENSATION LAWS OF THE STATE OF CALIFORNIA.
®u
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop.Line
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer
Waste Disposal
Wash Troy STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink 8 Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader ' Storm Drain Fee
Sprinkler System Water Sys. Fee
Relief Value Gas Fee
' Vac Breoker
Skimmer
Filter
Pool Sweeper
Permit Fee 3 ��
Total Total Fee s, 6rw
A/8! O SA aTTuck Dr . LOT NO. ✓�I
NO. STREET
CITY OF CUPERTINO" (((VAL.d c r kPPCIC`ATION FOR BUILDING PERMIT CAP. {
t FEE
Z Z Building Per.No.
0 ggtt Q ,19_.
OLL -t'LVL1 Sanitary Per.No.
3 v Application is hereby made for a permit to all /nf
F a L story, Type Structure
F to be occupied only as in accordance with
a
Zu, Plans, Specifications and Plot-Plan filed herewith. 'f� 8—
,,, = Estimated Value of Improvements, $
LL PI Ck Fee$ — 0 -
0 O It is hereby agreed that the requirements of the
3 Cupertino Building and Zoning Ordinances and all Fee$ '
0 a other lows applicable to the construction, location,and ADL=, 2,
Z use of buildings within the City of Cupertino will be Total Fee$_ L.
L zo complied with.
3Q
N
Mark (2,a Ae-A •2SS 4? 7 sa.»e- _
OWNER PHONE ADDRESS
O F SR Me . SRI
a O CONTR.OR AGENT AD ESS
_ V
PHONE STATE LICENSE
oWLUINUINSFtLIOR
O�.