51112 100 o
No. Stree 11r1
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No.
- Sanitary No.
Date 196
Application is herehy,made for a permit to
a story, Type
to he occupied only as
in accordance with plot Plan, Plans and Specification filed herewith„
Estinmted Value of Improvements '$
FEES Plan Check $
Owner 1�A Address
Cont;. Address
phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date 196 GAS FEE $
PLUMBING FEE $
Cont,. Address
Phone State License
Approved'
/ 1� APP CATION FOR APPLIANCE PERMIT-
Date - ,[� 196 y FEE$ � "z'—
Cont,: Address ^119 -
phone', �3-9" b .��P f' State License 720 3
Approved
Applicants agree not to violate any of the
lyorkman's Compensation Laws of the
State bf California _
RECORD OF INSPECTION APPROVALS
FOUNDATION BUILDING
UNDERFLOOR
Date Inspector
-
FRAME Date Inspector
�
LATH & PLASTER Date Inspector
FINAL Date Inspector
Date Insoector
ELECTRICAL
,OUTLETS
SWITCHES UNDERGROUND SERVICE SIZE
RECEPTACLES ROUGH WIRING Date Inspector
FIXTURES FINISH WIRING Date Inspector
Date Inspector
H.P. CHARGE FIXTURES
PERMIT FEE Motors Date Inspector
fl
TOTAL FEES FINAL Date Inspector
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
Da to - 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
BLOWER FURNACES COMBUSTION VENT
SUSPENDED UNIT MISC
GAS RANGE MISC
GAS DRYER I I PE IT FEE �-
FLOOR FURNACETO FEE "
INSPECTED I0 vi
ew-
DJte I Inspector
82-9010 6-e4 1.000 Paoli , ^
NOTICE TO CUSTOMER /cl �gw
Time.. /
CItY:= �'.'X-,.. .......................:...of Da ...•/•�'4r�'I/''
While Ale P. G. & E. does not assume and is not charge¢ble with any responsibility
for the condition of your equipment, Its repreSbntative while,on youryy''e ises today
observed the following condition affecting the use of the circled Item: g�lectrlclty,
,a.eam, water, Served y P. G. & E,�-namely-
4 r
T condition Is considered:
.:. IMPROPER OPE It
IL Quid -be"corrected or
I hereby acknowledge receipt
,paired as soon as possi o �tit,'�^forego�,. Is'N�gtice lie.,!
.......UUNSAFE AND IMMINE ZA •DOUB. As .a �-�1{"; day'o P'`�::!:'....~�S..J' .
r t, the``;following wa o
Vilmapntas di onn ehut off at t mete r cr n. (Cuefomer's signature).
as t o f�a por safe-
rovid n )ng final c r ctiou. If PACIFIC GAS AND
this condition is n t corre ed wlnext few ;ECTRIC COMPANY -
days, equipment will be Isco ce�• ✓
shut off.
1`d^•'.\'-11X. Y.� Original fpr veto a . Duplicate for ompany �y�., -.......'u�tiv-
t a o w �� (Its repr?en
Rules approved by the Public Utilities Commission of the State of California are available at Company offices.
Rule No.*11 includes the following provisions:
(D) Unsafe Equipment:
The Company may refuse.to serve or may discontinue service to a customer (a) if any part of
his facilities, appliances or other equipment for receiving or using service or the use thereof, shall
be determined by the Company to be unsafe, (b) If the Company Is notified by a public authority,
having appropriate Jurisdiction, that continued service to a customer Is in violation of applicable
laws, ordinances, rules or regulations of public authorities,or (c) if any condition existing upon the
customer's premises shall be determined by the Company to endanger the Company's service facili-
ties, until the condition specified In (a), (b) and/or(c) shall have been corrected by the customer.
The Company does not assume the repponsihility of Inspecting or repairing the customer's
facilities, appliances or other equipment for receiving or using service, or any part thereof, and
assumes no liability therefor.
(E) Service Detrimental to Other Customers: '
The Company will not provide service to utilizing equipment, the operation of which will be
detrimental to the service of the Company or its other customers, and will discontinue service
to any customer who shall continue to operate such equipment after having been'given notice
by the Company to cease so doing.
(I) Restoration—Reconnection Charge:
The Company may require payment of a reconnection,charge iof 82.60 before restoring service
that has been discontinued for nonpayment of bills or for failure otherwise to comply with filed
miss or tariff schedules.