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No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
Sanitary No.
File
Date 196
Application is hereby made for a permit to
a story, Type
to be occupied only asQnlli�
in accordance with Plot Plan, P ns and Specification filed herewith,
Estimated Value of Improvements $
FEES (� *a Plan Check $
Owner 7/ W Address
47 V
Contr. Address
Phone s!2zJ .3-3 State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEES
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date 196 GAS FEE $
PLUMBING FEE $
Contr. Address-
Phone Stare License
Approved
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 _
RECORD OF INSPECTION APPROVALS
BUILDING
DATE INSPECTOR MISC.
PAD FINAL
FOUNDATION
UNDERFLOOR
FRAME
LATH & PLASTER
GRADING FINAL
FINAL BLDG.
ELECTRICAL
DATE INSPECTOR MISC.
UNDERGROUND ROUGH
ROUGH WIRING
FINISHED WIRING
FIXTURES
MOTORS
FINAL tl4l
PLUMBING, GAS & APPLIANCE
DATE INSPECTOR MISC.
BACK FLOW REQ.
SANITARY N0.
UNDERGROUND ROUGH
PARTIAL ROUGH
ROUGH COMPLETE
MAIN DRAIN
FINAL PLBG.
FINAL GAS ,
FINAL APPLIANCE
DATE INSPECTOR MISC.
MISC
MISC
MISC
10d rc�
m NO. s'fa 1!LT LOT NO.
Z Z
r ° PL FOR ELECTRICAL PERMIT
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3 D ITY OFCC�UfPGRTINO /
o 19v--F Permit No.
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i Q11y li�`on mmtplNo the City of Cupertino for a permit to install electrical
w = r n'' and/or fixtures as listed on the reverse side hereof, and agrees to install said
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w wiring, and/or fixtures in accordance with the provisions of the Electrical Code of the
00
> m City of Cupertino, a 111 other Taws applicable thereto.
__j Use of Premises---- � 5/
J o J (�. rs2 y Adds/d2)z 6ce ,sy
Owner res
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By Address
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CONTRACTOR, AGENT G(J
`u 'LS 3 - S33 3 Approved Ol
/
Phnnc: r ELECTkICAL IN6►ECI
State License
W �� $ �I
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Hill
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