FILE 51114 Lot No.
No. Street
APPLICATION FOR BUILDING PER
CITY OF CUPERTIN6
File No.
Sanitary No.
Date 196
Application is her e y m e for ape o
a story, Type
to he occupied bol as
In accordance with Plot plan, Plans and Specification filed herewith,
Est[ved Value of Improvements $
FEES Plan Check $
Owner Address
Contr. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEES
Contr. Address
Phone qssev,, State License
® Approved
IL TI�1� Fri 41- NG 3 GAS PERMIT
Date 196 GAS FEE $
ITYOOF CUPERTINO
P`LUM81NG FEE $
Phone '�" State License
Approved WILLIAM D. 13ENEVirg
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEES
Contr. Address
Phone State License
Approved
Applicants agree not to violate any of the
Workman's Compensation Laws of the
State of California
t�
RECORD OF INSPECTION APPROVALS
BUILDING
FOUNDATION
Date Ins pe ctor
UNDERFLOOR
Dote Ins pactor
FRAME
Date Inspector
LATH & PLASTER
Date Inspector
FINAL
Date Ins oe c tar
ELECTRICAL
,OUTLETS
- SERVICE SIZE
SWITCHES . UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
Date Inspector
FIXTURES FINISH WIRING
Date Inspector
H.P. CHARGE FIXTURES
Date Inspector
PERMIT FEE Motors
Date Inspector
TOTAL FEES FINAL
Dote Inspector
PLUMBING & GAS
MAIN DRAIN SIZE I I MATERIAL
STORM DRAIN I SIZE I 1,2116TERIAL
WATER SYSTEM SIZE IATERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Data Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Dare Inspector
STORM DRAIN FEE MAIN DRAIN
Date Inspector
WATER SYSTEM FEE GAS PIPING
Data Inspector
GAS PIPING FEE - FINAL
Date Inspector
PERMIT FEE MISC
Date nspector
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
Date Inspector