NO PERMIT NUMBER l0 d $ec I oe At2 f Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO Q
File No.
Sanitary No.
Data � 196
Application is hereby made for a permit to w
astor , Type - O/ 1
to be occupied only as �/ �d • D N
in accordance with plot plan, klans and S ecification filed herewith,
Estimated Value of Improvements $
FEE$ TJ
Pion Check E
Owrmr _ Address
Contr. /�� •� Address
eL
Phonj<G State License
Approved _
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Dote 196 GAS FEE $
PLUMBING FEE $
Contr. Address
Phone State
License
Approved
APPLICATION FOR APPLIANCE PERMIT
Data 196 FEES
Cont,. 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
FOUNDATION BUILDING
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Date Inspector
LATH & PLASTER OCI
Dyte � spa etor
FINAL
Date Insoectar
ELECTRICAL
,OUTLETS SERVICE SIZE III
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
Date Inspector
FIXTURES FINISH WIRING
Date Inspector
H.P. CHARGE FIXTURES
Date Inspector
PERMIT FEE Motors
Date Inspector
TOTAL FEES FINAL
Date Inspector
PLUMBING 8 GAS
MAIN DRAIN SIZE I I MATERIAL
STORM DRAIN I SIZE I L.M.66TERIAL
WATER SYSTEM SIZE IATERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Dots 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 PERMIT FEE
FLOOR FURNACE TOTAL FEE
INSPECTED
Date Inspector