51179 103171 ���! � a-4 . Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No. d7eol7
s
Sanitary No.
Date 196
Application is hereby made for a permit to
7, Type
to be occupied only as
in accordance with Plot Plan, Plans and Specification filed herewith,
Estimated Value. of Improvements S /A 4)Q 4=-
FEES
r� Plan Check E
Owner _ / /iJJJ�� Address
Contr. Address Z � Wim...
Phone J-9 f54ay State License Va.*� 7L
Approved �. �.
APPLICATION FOR ELECTRICAL PERMIT
Date - 196 FEES -
Contr. Address
Phone State License
Approved
C
APPLICATION FOR PLUMBING 8 GAS PERMIT
Date 196 GAS FEE E
PLUMBING FEE E
Contr. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEES
Contr. Address
Phone t 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
Date Inspector
LATH & PLASTER
_6 Ins petro
FINAL
Date Inspector
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
Data Inspector
TOTAL FEES FINAL
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE MATERIAL
WATER SYSTEM SIZE ITERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Date Inspector
STORM DRAIN FEE MAIN DRAIN
Date Inspector
WATER SYSTEM FEE GAS PIPING
Date Inspector
GAS PIPING FEE FINAL
Date Inspector
PERMIT FEE MISC
Dote 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 Inspector
1OT NO.
NO. STREET
3 APPLI�ATWN `FOR BUILDING PERMIT
r ° / CITY F �CUPERTINO
S < jr�jJ'IY11 1968 j Sanitary No.
� �-r17g
Date 196_ Permit No.
r o
o < Appli¢ation,is her�byv3de 5r'kTp'mi`lto -7�
i m story, Type . Building
r to be occupied only as'57 s* ��D.� c �°d`Q o70 X 9 in accordance with
9 o Plans, Specifications and Plot -Plan filed herewith. PI Ck Fee
Fg Estimated Value of Improvements, $ �3o O �? Fee $
iJ It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
J Z all other laws applicable to the construction, location, and use of buildings within the City of
O Cupertino be comp d with.
3 Owner �' Address�M'
-m
a By atc-` c�-� Address pp��4//-"D--�
< 0 Phone Approved�V/!l1MM�`+`
State License/1766-
"w_ -�/ BUILDING INSPECTOR /