NO PERMIT NUMBER Lot No.
No. Street 10/
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
/ File No. �.r/d 0'4
nary No.
Date 196
Application is hereby mar for a p mitt
story, Type
to be occupied only as
in ac o a h P10t plan, Plans and Specification filed herewith,
Eetimn .lue of Improv.manes $
FEES Kn if Plan Check $
Owner 1 $ w6&d® Address
Contr. a Address
..Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
Cont,. Address
Phone State License
Approved
1
4D54PL MING & GAS PERMIT
Date. 196 GAS FEE $
::PITY OF COPE/,RT-I • PLUMBING FEE t _
Contr. W Address /
Ph o1nel S� — �� �� State License
C.P
Approved ZZ —
`_ APPLICATION FOR APPLIANCE PERMIT
Dote 196 FEE$
Contr. Address
Phone State License
Approved
Applicants agree not to violate any of the
Workman's Compensation Laws of the
State of California
RECORD OF INSPECTION APPROVALS
BUILDING
FOUNDATION
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Dote Inspector
LATH & PLASTER
Data Inspector
FINAL
Date Insoectar
ELECTRICAL
,OUTLETS SERVICE SIZE
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
Date Inspector
FIXTURES FINISH WIRING
lY
Date Ins pactcvr
H.P. CHARGE FIXTURES
Date Inspector i
PERMIT FEE Motors
Date Inspector
TOTAL FEES FINAL
Date Inspector '
PLUMBING & GAS
MAIN DRAIN SIZE I MATERIAL
STORM DRAIN SIZE LolhLTERIAL
WATER SYSTEM SIZE ITERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH -
Dote Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Do to Inspector
STORM DRAIN FEE MAIN DRAIN
-' Data Inspector
WATER SYSTEM FEE �e GAS PIPIN
Dftg for
GAS PIPING FEE FINAL s 42
Date Inspector
PERMIT FEE � MISC
ate Inspector
TOTAL FEE - �� MISC
Date Inspector
APPLIANCE
TYPE OF APPLIANCE UNITS FEE TYPE OF APPLIANCE UNITS FEE
CIRCULATING HEATERS REGISTERS
BLOWER FURNACES COMBUSTION VENT
SUSPENDED UNIT MISC
GAS RANGE MISC
GAS DRYER PERMIT FEE
FLOOR FURNACE TOTAL FEE
INSPECTED
Data Ins pec for
Zbbtti '
LOT NO.
NO. STREET
Zi Gt G�Vtv. o ae I' OF CUPERTINO
Yo 0101�) APPLICATION FOR ELECTRICAL PERMIT
OLL ,QN
3J
a ` Permit No.
�0 19Ly Fee$
o r App cation is hereby made to the City of Cupertino for a permit to install electrical
>, r wiring and/or fixtures as listed on the reverse side hereof, and agrees to install said
a" wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
,:E City o p rtinc, and all other laws applicable thereto.
a �
J�
20 Use of Work To B
>m Premises I Perfo.metl
F Q
' OQ� Owner IC7% /t --(.w-,-.+/ AtltlreuMElectrical
�ZOey AddressContractor,Aggeent
a Phone .lo . 4).21
96State License � Approved
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