51112 00 0 Lot No.
No. Str IV
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No.�///02-0'
Sanitary No.
Date 196
Application is hereby made for a permit to
a story, Type
to be occupied only as
in accordance with Plot Plan, plans and Specification filed herewith,
Estimated Value of Improvements $
FEES Plan Check $
Owner Address
Contr. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
�p
Date //� 196 -S FEES C0.7— D4
Contr. Address
Phone 0Z State License ;6? gljaZ
Approved
APPLICATION FOR PLUMBING 8 GAS PERMIT
Date 196 GAS FEE $
PLUMBING FEE $
Contr. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 1% FEES
Contr. Address
Phone State License
Approved ^'
Applicants agree not to violate any of the '
Workman's Compensation Laws of the
State of Ca lifom is
RECORD OF INSPECTION APPROVALS
FOUNDATION BUILDING
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Date Inspector
LATH & PLASTER
Date Inspector
FINAL
Date Insoactor
ELECTRICAL
,OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
Data Inspector
RECEPTACLES ROUGH WIRING
Date Inspector
FIXTURES FINISH WIRING
Date Inspector
. CH GE FIXTURES
Date Inspector
PERMIT FEE ov Motors
D to Spector
TOTAL FEES 02- FINAL
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE TERIAL
WATER SYSTEM SIZE TERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEEROUGH 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
Date Inspector
TOTAL FEE MISC
Date Inspector
APPLIANCE
TYPE OF APPLIANCE UNITS FEE TYPE OF APPLIANCE UNITS FEE
CIRCULATING HEATERS _ REGISTERS
t
BLOWER FURNACES - COMBUSTION VENT
SUSPENDED UNIT MISC
GAS RANGE MISC
GAS DRYER PERMIT FEE
FLOOR FURNACE TOTAL FEE
INSPECTED
Dote Inspector
AGREE I WILL NOT VIOLATE ANY OF THE WORKMEN'S
COMPENSATION LAWS OF THE STATE OF CALIFORNIA.
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