NO PERMIT NUMBER (2) 21841 McClellan an Rd.
NO. STREET LOT NO.
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CITY OF CUPERTINO
APPLICATION FOR BUILDING PERMIT
I
SANITARY NO,
FILE NO. 5i,47o
DATE .Tan. 9 19 79 ,
Application is hereby made for a permit to
r�yn g+rnr+. a story,type
to be occupied only as rPrl rrnd 1i ark
in accordance with plot plan,plans and specification filed herewith.
ESTIMATED VALUE OF IMPROVEMENTS.$ 500
FEE$ 5.00 PLAN CHECK$ 2.50
OWNER Nancy B. Clark ADDRESS10546 Merriman Rd. Cupt.
PHONE 255-1968
CONTR. ADDRESS
PHONE STATE LICENSE
APPROVED
BUILDING INSPECTION RECORD
DATE INSPECTOR DATE INSPECTOR
FOUNDATION FLOOR STEEL
PRE-GUNITE FRAME
BOND BEAMS LATH
WALLBOARDS-INT.&EXT.
FIREWALLS
MEMBRANE LANDSCAPING
F.M.O.INSPECTION
FINAL BLDG.
UNDER-FLOOR
TIEDOWNS 1 -MISC-
DIAPHRAMS
MOORE 0 USI N E ss FORMS INC..Li
ELECTRICAL INSPECTION RECORD
RESIDENTIAL DATE INSPECTOR- COMMERCIAL DATE INSPECTOR
UNDERGROUND ROUGH UNDERGROUND ROUGH
ROUGH WIRING 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 =S.M.
DATE INSPECTOR
EPARTIALROUGH
EQUIRED .M.NSTALLED ATIOND ROUGH AIRH RAINSPLETE CE
& LEADERS
MAIN DRAIN
FINAL GAS
FINAL PLUMBING
MISCELLANEOUS
CITY OF,CUPERTINO
TEMPORARY ELECTRICAL SERVICE
DATE: -------�5 ( �7�
-7 1 Fee: SM.....t7!�.................
.................. ------I.................
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OWNER: --------Qq� .
AT: .... ------NN-c--c-t...Q-,-k...
............ - --- ----------
LOT: ...... Nip.................. ................ ......................................
REASON: -----------
............ ...... ...t4�..................
The undersigned agree to be res onsible for the electrical service at the above location,
until the building isr ady fdToccupancy, and is released by the Building Department,
City ol' Cupertino. - I
Phone ...... .....................
.........................
.........................INSPECTOR .
..............
INSPECTOR TENANT OR OWNER
117 1/63-500 PD-4
8q meat/146, ed. LOT NO. I�✓
NO. STREET
CITYOFCUPERTINO VAL.` S/�
C-7-1.1fC�.?�^'"':.i7:lO CAP.
a APPLICATION FOR BUILDING PERMIT EEE rJ�
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Building Per.No.�"f 74
W TaN , 19 9.
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Sanitary Per.No.
3 V ApPliCatios is�i reby made for a permit to
a L-ND story, Type Structure
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w w to be occupied only as c=/JC../ i a)j (�[:TLX in accordance with
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i w Plans,Specifications and Plot-Plan filed herewith.
w Estimated Value of Improvements,$-5 S�4
a w PI Ck Fee$
O O It is hereby agreed that the requirements of the
> yr Cupertino Building and Zoning Ordinances and all Fee $
other laws applicable to the construction,location,and '7 S�
O a Total Fee$
z - use of buildings within the City of Cupertino will be
zz complied with. n/f o
3 N '�t_e�tyauI ER.� 255- /oS'(6 Mu +�M_ 0���1
w Z I OWNER PHONE ADDRESS
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QCONTR.OR AGENT A RESS
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l� PHONE STATE LICENSE B LIJINU INSPE OR
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