15864 I -
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBEN
I CITY OF CUPERTINO i $r�
INSPECTION DIVISION
JOB'•. INSPECTION RECORD L 1
Co'. o PERMIT EXPIRATION
JOB ADDRESS i 19Z- TO Inl '�f RInC UNITS _LOT# 1
PERMIT EXPIRES IF WORK
uwrvER �` �p1',�R.,C G`I1QC1U CONTRACTOR Czi2�-,pmt Q IS NOT STARTED WITHIN
INSPECTION .' DAT INSPECTOR INSPECTION RECORD - 18oDAYS OFPERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM
NOTE:
• UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF Pn+An1 VAI.IPA nnN
CUPERTINO STANDARD
• GARAGESLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB , ."
, .1�
PLUMBING ��, "� "
ELECTRICAL .i AI-TI IL� ISSUANCE RAIE
MECHANICAL I .I I, Dole. ELECT. rul. mLCIT
S WL`P Z-
�;,,o D 1 0
DO NOT PON FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT,
WOOD FLOOR - INFORMATION '
PLUMBING VALUATION SIFT.
MECHANICAL 1&20727
ELECTRICAL
_ vERMn ru
FRAMING v I L
INSULATION SIGIIILs IVPE CONS 111
UCC m10UP RES UNITS
V1�1�
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 64l dc� Czoj, V-1
SO11.IIUOJIn.'A 10TALACREAGE
• ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM I I THE CONSTRUCTION TAX IS PAID n
ROOF SHEATHING Res INIDD"uU CINc usF.
ON FB OIL..,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATF El 0 ❑ 11 0
ASSESSORSPARCEL NO
ROUGH SAN.a 'JOS
PLUMBING ELECT.ENERGY V'1'.3/ 3r)J_
,
TUBS&SHOWER PAN n1ACI NO PARCEL NO
(� PLUMBING ENERGY /�"
MECHANICAL MECH.ENERGY. ` ��y e
ELECTRICAL F3 I ft
BUILDING ENERGY Acc.Onre ncc FMNO
FRAMING ELECT.FINAL TEST
INSULATION
ZONING ENG.SITE NU.
PLUMBING
GAS TEST GAS 17
MECHANICAL FIR $PHINN ENERG''T71
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "[:]
� EXTERIOR SHEAR ELECTRICAL RELEASE ROOD JUNE AL UC
INTERIOR SHEAR7-L( ocl- FIRE DEPT, T N[ L "�
SHEETROCK GRADE _
' FEE SUMMARY:.:;1•%"���
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS 6uILDING v.%t a)
SCRATCH COAT 7 ELECTRIC PLAN CHECK fJ�
GAS FEE 1
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occuPANcv SEISMIC FEE R
10-71
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM
L ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
• F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
OPLEASE GIVE JOB ADDRESS WHEN PHONING.
z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE — 0
IMPORTANT! CONST.TAX W.w
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. t "^•1 ` : '
APPLICANTS POSTING COPY 1
z
_CITY OF CUPERTINO
CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE
Building Peit No. I.�
Date .�..1C ..k
The Building Located at _--.. ...1. .....1_ .......1....1"�..�. .�..).. ...0 L.f
Owned b �c>.��
r ......... ..b.I�..`(. .... O.0�....................
Complet
Has Been � tele ) For Use As: ........ .i...fi.-�......... .......Y`�-�------..........
.................................................................................................................................................
................................................................................ ..
..... ... ........... ..
................
...................Ll... ...... .®. ....
PD-7 BUILDING INSPECTOR
CITY OF CUPERTINO 15864
INSPECTION DIVISION
JOB INSPECTION RECORD
ty 4 r, �J PERMIT EXPIRATION
JOB ADDRESS 11��1Z T�inl�v �P�nq UNIT# LOT# J
• 1p�� ��p 7 E�� PERMIT EXPIRES IF WORK
OWNER C�'Y01�.� �L.( CONTRACTOR 6��QQ{ IS NOT STARTED WITHIN
INSPECTION - DATE INSPECTOR - INSPECTION RECORD 1 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM
NOTE: LAST GALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
PREGUNITE CUPERTINO STANDARDS. '
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB tl
PLUMBING 1 .
ELECTRICAL U ISSUANCE DATE
MECHANICAL \`�,.� N BLDG. ELECT. PLG. NEC.
S Wz� ff iZ. p. +'✓ {tile ❑ 10 0
DO NOT POOR FLOOR UNTIL ABOVE HAS BEEN SIGNED Ali :.BUILDING PERMIT
INFORMATION
WOOD FLOOR _
VALUATION S/FT.
PLUMBING
MECHANICAL 152,,727?
ELECTRICAL PER., To
FRAMING cr,v I L
INSULATION _ STORIE TYPE CONSTR.
OCC.GROUP RES UNITS
.oww
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED oF� -
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE $O Fr.FLUOR ARE. TOTAucaEAGE
I DIAPHRAGM THE CONSTRUCTION TAX IS PAID �.
BUILDING USE
• ROOF SHEATHING 1Q 1� 1 RES IND Cori PR DIS.,
APPLY NO ROOFING'UNTIL ABOVE HAS BEEN SIGNED j f'aS5%fINALS°'i=`` t -_-DATE0 ❑ 0 ❑ 0
ASSESSORS PARCEL NO.
' ROUGH SAN.p (/ /
PLUMBING ELECT.ENERGY �� "jY 6-U�"��..3�11
TUBS b SHOWER PAN PLUMBTRACT NO. PARCEL NO.
ING ENERGY
MECHANICAL MECH.ENERGY I) d
ELECTRICAL BUILDING ENERGY ACC.DATY ACC,FICENO.
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING ZONING ENG.SITE NO.
GAS TEST GAS
MECHANICAL FIRE STRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y.[] "� Y "�
EXTERIOR SHEAR
ELECTRICAL RELEASE
FLOOD ZONE A.L.U.C.
INTERIOR SHEAR Z,L C FIRE DEPT. Y Y ❑ "0
SHEETROCK GRADE -' FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH O TEMPORARY APPROVALS - = BUILDING • ,
SCRATCH COAT ELECTRIC PLAN CHECK IJ
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0- PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL x
IMPORTANT! CONST.TAX $257.03
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. I It ", x -
APPLICANTS POSTING COPY
CITY OF CUPERTINO rgC
INSPECTION DIVISION
JOB INSPECTION RECORD
I' //''��--77 T ` ,,nn PERMIT EXPIRATION
JOB ADDRESS ! �,`"IL T AnI}V Spf�nq `M' UNITJI _LOT#
/��p� ! .n PERMIT EXPIRES IF WORK
OWNER ( W--1E& Y C-AlanQp. CONTRACTOR �C ( �y IS NOT STARTED WITHIN
INSPECTION DATt INSPECTOR INSPECTION RECORD 1 180 DAYS OF PERMIT ISSU.
FOUNDATION ,�Z -� ANCE OR 180 DAYS FROM
NOTE: LASTOALLED INSPECTION.
LIFER NOTE!
GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE .47 TO COMPLY WITH THE APPROVED PLANS AND CITY OF PEHMIT VALIDATION
CUPERTINO STANDARDS.
GARAGESLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB . F11
PLUMBING12
p
ELECTRICAL nUBU
ssuANCE DATE
MECHANICAL �, ELECT. PLG. MECH
s1� Q .2 a o aDO NOTPO R FL00R UNT ILDING PERMIT
IL ABOVE HAS BEEN SIGNEDINFORMATION
WOOD FLOOR
PLUMBING VALUATION
MECHANICAL ?
ELECTRICAL PERMIT TO
FRAMING =v I L
INSULATION _ STORIES"' TYPE CONSTR.
h�
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED � Ott '-
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO'IT FLOOR AREA TOTAL ACREAGE
I, DIAPHRAGM THE CONSTRUCTION TAX IS PAID V
K_14`1
euaomN-USE
ROOF SHEATHING 1WIP2
RES Ino con Pe D
APPLY NO ROOFING UNTIL'ABOVE HAS BEEN SIGNED '.;FINALS _�;jDATE .INSP:!, 0 EL
ROUGH SAN.H ASSESSORS PARCEL NO
PLUMBING ELECT.ENERGY
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO. PARCELNOG (�
MECHANICAL MECH.ENERGY Pb 5 6
ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILE NO
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS TEST GAS
FIRE SPRINK ENERGY T 24
MECHANICAL Y O N� Y ❑ NE]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.L.0 C,
INTERIOR SHEAR FIRE DEPT. YE] N0 Y L N0
SHEETROCKGRADE FEE SUMMARY
EXTERIOR LATH BUILDING I i
INTERIOR LATH TEMPORARY APPROVALS—
SCRATCH
PROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK �J✓
GAS FEE Emm
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY -SEISMIC FEE 1,10.71
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDI NG FINAL IS SIGNED BY BUI LDING INSPECTOR. MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC Dew
I—� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING t-
0- PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL x
• IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. t x
APPLICANTS POSTING COPY
POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 15864
.INSPECTION DIVISION 303,
T JOB INSPECTION RECORD
r - PERMIT EXPIRATION
JOB ADDRESS X/qZ �"'�" ` ��"�'"""� —` UNIT# LOT',t I -
,p - PERMIT EXPIRES IF WORK
OWNER V-* CONTRACTOR �teco l( " IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECOFID 180 DAYS OF PERMIT�ISSU-
FOUNDATION ANCE OR 180 DAYS FROM ;
.. NOTE: LAST CALLED INSPECTION. '
UFERALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED S '•, .y( ��'�w�--%
UNDERGROUND /SLAB - �(
d
PLUMBING � O %
ELECTRICAL ISSUANCE DATE
MECHANICALD ur ELECT PLc. MECR
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING,PERMIT
WINFORMATION
WOOD FLOOR
VALUATION SIFT.
PLUMBING' -
MECHANICAL
PERMIT TO
ELECTRICAL
FRAMING I(,
SIORI[ TYPE CONSTR.
INSULATION
- OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
sa FT 'LUVII AHEA TOTAL ACREAce
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID
BUILOING USE
ROOF SHEATHING L{A&-eF, - I
RL$' 'NO CON PB OiL+
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 'FINALS DATE INSP. d 0 Ej 0 0
// ASSESSORS PARCEL NO.
ROUGH SAN.N 3N��O9 c3� j .
PLUMBING ELECT.ENERGY
TUBS'&SHOWER- AN, - PLUMBING ENERGY TRACT No. PARCEL No
, MECHANICAL r MECH.ENERGY
ACC DATE ACG FILE NO
ELECTRICAL . . BUILDING ENERGY
FRAMING - �.. ELECT.FINAL TEST
_ ZONING ENG.SITE NO. .
'INSULATION . G-S� PLUMBING
GAS TEST- GAS
FIRE SPRINK ENERGY TP<
MECHANICAL r ❑ N❑ v ❑ N�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR.SHEARELECTRICAL RELEASED I
LLooU ZDNE 'a,Luc
INTERIOR'SHEAR ..r. 0 X- 1FIRE DEPT. °❑ NE] I Y0 NO
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS_ BUILDINGINA
SCRATCH COAT., ELECTRIC PLAN CHECK 15m
_ - GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY. SEISMIC FEE tin 71.
OCCUPANCYOF BUILDING IS NOTPERMITTED.UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING.252-4505, ELECTRIC
H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O�. PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE — WAS
IMPORTANT! coNST.TAX
PLEASE' READ.REVERSE SIDE BEFORE TOTIAL
CALLING FOR FINAL-INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENTIFICATION -PERMIT NUMBER /
BUILDING APPLICATION & PERMIT q [p A
A�'s117OZTrtitySpriA,K; ric BUILDING -ELECTRICAL-PLUMBING-MECHANICAL IJQ `.F
OWNER'5 (].p..nyal f].xr ret D PLAN CHECK VALIDATION
NAME "''`Jwr.7 Group, Inc.1oI QTY. ELECTRIC PERMIT FEE
AinanSan De4e'WWnt PHONE 415/595-2100
NAME crams UTLETS-SWITCHES-RECEP 10.00/1.00
NfONEACTOn fy��I.,
wx-`gx Duip+ Imo• uc.No.B-4��7 LIGHTING FIXTURES 10.00/1.00
COINTFIA CTOR's 2z _C Tenn Dolphin Dr PPLIANCES-RESIDENTIAL 4.00
AOOREsa N
M 94065 E.G., 415/695-21 PANELS 10.00 DATE OF APPLICATION '
ARCHITECT co bassenian, PANELS (OVER 200 AMP) 20,00 PLCKFEE . .
AN CHEC.NO.
tL.ENGINEER Associates LID.NO. C-8345 ISIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS 2031 rd Dr., MIX SPECIAL CIRCUIT 5.00
Santa Ana Hts.y CA iIP 92707 TEMP.METER OR POLE INS. 20.00
APPLICANTS
AMOTORS SEE FEE SCH. .
220-C Twin Dol phin DR. M 94065 SERVICE CHANGE 20.00
w 0 o LICENSED CONTRACTORS DECLARATION
u I hereby affirm that 1 am licensed under provisions of Chapter 9 - ISSUANCE DATE
N <ec (commencing with Section 71X0)of Division 3 of the Business and BLOC: ELECT. PLC. MECH.
H m z Professions Code,an6bny license is in full for�'�I'�Tfct. ,VK_--,(IY
z °w - License C17 Lia.Number
4 H ° Date `L- Contractor. BUILDING PERMIT
H
a < OWNER-BUILDER DEC LARATION
w r 1 hereby affirm that 1 ren exempt from the Contractor's License
M ISC.- REFER TO OR INFORMATION
m ALUATION S/FT.
HN0< Low for the following reason.(Sec.7031.5,(business and Professions PERMIT ISSUANCE X00 \��
Cale:Any city or county which requircx a permit to construct,alter,
- 1 ��
x ¢ 0 improve,demolish,of repair any sInmlurc,prior to its issuance,also ELEC.CONTR. LIC.NO. ' ELEC. 0 p
n - °Q requires the applicant for such permit to File u elgned statement that TOTALTO
K
he is licensed pursuant to the provisions of the Contructoi s License !F�j
Law(Chapmr9(commencingwithSuWian7000)of Divisin 3 nftheBusiness and Professions Code)or that he is exempt therefrom and GTY. PLUMBING PERMIT the basis for the alleged exemption.Any violation ofSeclion.7031.5 TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penaltyALTER-DRAIN&VENT-WATER (EA.) 5.00of not more than five hundred dollars(5500).): 5N-R
O 1,at owner of me property,FT my employ.with wags as BACK F LOW PROTECT. DEV ICE 4.00RES.UNITS
their sole compensation,will do the work.and the structure isnot
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractors License Law does not apply to an owner of R-3 1
properly who builds or improves(hereon,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-
ments are not intended or offered l'or sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 2349
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 ofproving that he did not build or im-
noveforpurposeofsale.). INDUSTRIAL WASTE INTER. 30.00 E . IND CDN PB Other
0 1,m owner of the properly,um exclusively contracting with ❑. .❑ ❑ ❑
licensed contractors to construct the project(Sec. 704,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL No.
and Professions(,WC:The Contractor's License Low dues not apply 33 99
to an owner of property who builds or im3� 33
proves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 09-�/ 3�'
contracts for such projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARYEA.200ft/10.00 TRACT NO. PARCEL NO.
0 I am exempt under Sec. .B.&P.C.for this WATER HEATER W/VENT 6.00 VV 90p
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC FILE NO.
W'ORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have u certificate of consent to selfinsure, ZONING
or a certificate of Workers'Compensation Insurance,or a ceftit i .cd ENG.SITE NO.
copy foreoC(See.3800,Lnh.C.). United Pacific '
Policy No. Company
O 0 Certified yls hereby furnished. FIRE SPRINK ENERGY T-24
Z 2 /��CcrtiO fl��w�vth he city inslwction division. MISC.- REFER TO ORD.
Fp 1CppTant �lI1 1 V ❑ •N❑ v ❑ N❑
CC T CE RTI FICATE OF Ii X EMYT ON PROM WORK Ii RS' PERMIT ISSUANCE 10.00 PLooDZONE A.L.U.C.
LUQ COMPENSATION INSURANCE. PLG.CONTR. LIC.NO. PLG. L�j Y❑ N❑ V❑ N❑
CL Z (This section eed not be completed if the permit is for one TOTAL
hundred dollars(S 100)or less.)
U O 1 cmify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
O become Subject to the Workers'Compensation laws of California.
O i Ualn Applicant - ALTER OR ADD TO MECH. 5.00 BUILDING $86.00
} N NOT ICE TO APPLICANT: 11,after making this Cco&,I to of Ex
F Z entption,you should become.subject to the WOrkers'Compensmion APPLIANCE 5.00 PLAN CHECK50
provisionpf, the Labor Code, you must forthwith comply with
U ,ouch provisions or this permit shall be demncd revoked. AIR HANDLING UNIT(TO 10=C.F.M,) 4.00 FEE 16-00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.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
r o C ince of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name $eQlrlt Pacific r�
Lender's Address .- -- HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 4U/ 35
r
I certify that 1 have read this 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-OONP(3H.P.or100,000B.T,U.) 6.00 $60.35
-� hereby authorue representatives of this city to enter upon the BOI LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
ebovrmcntianed property for inspection purpo s. 35
(We) agree to save, polenmify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
nay in any way accrue against said City.in consequence of the
u I this permit MECH.CONT. UC.NO. MECH.
YW, 'Dole
TOTAL TOTAL
Signalureof Applicant utrador Daze 19 G1- 1391.29
OFFICE COPY