511143
No. Street
Lot No.
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No. 'X/115e
/ Sanitary No.
Dora � � 196 �10�
^ Applica(iOn is hereby made for n permit to �
y� yppe-- - sto aW%
to he ccufled only as
in accordance with Plot Plan, Plans and Specification filed herewith.
Estimated Value of Improvements
FEES
Owner', '
Or r
Contr. Atr-AW.a/
r
Phone 2- 3—
s 35y 6 =
Plan Check f
Address
Address jO /–r/ „j'rsra•� "–
State
-State License
r
Approved 40
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEES
Contr.
Phone
Address
State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date 196 GAS FEE $
PLUMBING FEE $
Contr.
Phone
Date
Contr.
Phone
Addres
State L
Approv
APPLICATION FOR APPLI
196 FEES
Addros
State L
Approv
Applicants agree not to violate any of the
91orkman's Compensation Laws of the
State of California
RECORD OF INSPECTION APPROVALS
BUILDING
FOUNDATION
Date Inspector
UNDERFLOOR
Dot Inspector
FRAME
D o I Inspector
LATH & PLASTER
t ns actor
FINAL
to to Ins oe ctar
ELECT CAL
Dote Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE MATERIAL
WATERS M iIZE
SERVICE SIZE
FEE
,OUTLETS
UNITS
UNDERGROUND
SWITCHES
FIXTURE FEE
Date
RECEPTACLES
Inspector
ROUGH WIRING
FIXTURES
Date
Inspector
CHARGEMIT
Data
ROUGH COMPLETE
FEEAL
E
FINISH WIRING
FEES
Inspector
STORM DRAIN FEE
Dote Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE MATERIAL
WATERS M iIZE
SERVICE SIZE
FEE
UNDERGROUND
UNITS
UNDERGROUND
CIRCULATING HEATERS
FIXTURE FEE
Date
PARTIAL ROUGH
Inspector
ROUGH WIRING
BLOWER FURNACES
Date
Inspector
MAIN DRAIN FEE
Data
ROUGH COMPLETE
Inspector
FINISH WIRING
Dots
Inspector
STORM DRAIN FEE
Dote
MAIN DRAIN
Inspector
FIXTURES
Date
Inspector
WATER SYSTEM FEE
Date
GAS PIPING
Inspector
Motors
Date
Inspector
GAS PIPING FEE
Date
FINAL
Inspector
FINAL
Date
Inspector
Dote Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE MATERIAL
WATERS M iIZE
MATERIAL
FEE
TOTAL FIXTURES
UNITS
UNDERGROUND
CIRCULATING HEATERS
FIXTURE FEE
PARTIAL ROUGH
BLOWER FURNACES
Date
Inspector
MAIN DRAIN FEE
ROUGH COMPLETE
SUSPENDED UNIT
Dots
Inspector
STORM DRAIN FEE
GAS RANGE
MAIN DRAIN
MISC
Date
Inspector
WATER SYSTEM FEE
GAS PIPING
FLOOR FURNACE
Date
Inspector
GAS PIPING FEE
FINAL
Date
Inspector
PERMIT FEE
MISC
Date
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
Dote
Ins po ctor
/o/ tj 1T
LOT NO,
W FfAPNG(
b
ION POR BUILDING PERMIT
r°CITY OF CUPERTINOo 9 1966 Sanitar} No.
sU �,�` E
_I.4.�,y gaup I^I 196 Permit No. v ���
o
city lic�tl��i4k��t1{1 gip�le for a permit to
a n/
i m a story, Type" i%J�d-[.[i1�- Building
aW
to be occupied only as in accordance with
0 'o Plans, Specifications and Plot -Plan filed herm,tth.ay. PI Ck Fee
"; Estimated Value of Improvements, 0 Fee $ J O'`
iJ It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
* Z all other laws applicable to the construction, location, and use of buildings within the City of
d 0 Cupertino will be complied wigi-
3:i t
— W Owne Address Cl _V_
W Z /
a n By Addres 0
au Phone Approved
2 Z S 2 PP BUILDING INSPECTOR Oct/
State Licens �/