FILE 51107.1IM"
No.
Street V
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
Dote / / 196 6—
P lication is herAy made for a permit to
to he occupied only as
Lot No.
File No. `5 7, /
Sanitary
story, Type
in accordance with Plot Plan, Plans and Specification filed herewith„
Estimated Value of Improvements $
FEES
Owner
Pion Check $
Address
Conte.
Address
Phone
Date
Contr.
Phone
State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
,... 196 FEE$
Address
State License
Approved
APPLICATION// FOR PLUMBING & GAS PERMIT
Dote l� 1961 GAS FEE $
PLUMBING FEE $ -3
Contr. Address �7a/(
Phone M2— � Z Z State License a'J(0�/'�3'C%
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 1% FEES
Conte
Phone
Applicants agree not to violate any of the
Workman's Compensation Laws of the
State of California
Address
State License
Approved
RECORD OF INSPECTION
APPROVALS
I �.
4
FOUNDATION
Date
BUILDING
SWITCHES
UNDER\GRblUND
RECEPTACLES
Date
Inspector
FIXTURES
Dote
M.P. CHARGE
Inspector
UNDERFLOOR
PERMIT FEE
ROUGH COMPLETE
TOTAL FEES
Date
Inspector
Dote
FRAME
STORM DRAIN FEE
MISC
Date
Inspector
FINAL
Date
Inspector
WATER SYSTEM FEE
Date
GAS PIPING
Inspector
LATH & PLASTER
_C / Date
or
f
GAS PIPING FEE
Date
� FINAL 6
Inspector
FINAL
Date
Inspector
PERMIT FEE
Date
MISC
Inspector
ELECTRICAL
Inspector
MAIN DRAIN
STORM DRAIN
SERVICE SIZE
UNDERGROUND
UNITS
I �.
4
,OUTLETS
Date
Inspector
SWITCHES
UNDER\GRblUND
RECEPTACLES
Date
Inspector
FIXTURES
M.P. CHARGE
Date
Inspector
PERMIT FEE
ROUGH COMPLETE
TOTAL FEES
Date
Inspector
MAIN DRAIN
STORM DRAIN
SERVICE SIZE
UNDERGROUND
UNITS
I �.
4
WATER SYSTEM
Date
Inspector
ROUGH WIRING
UNDER\GRblUND
REGISTERS
Date
Inspector
FINISH WIRING
COMBUSTION VENT
Date
Inspector
FIXTURES
ROUGH COMPLETE
MISC
Date
Inspector
Motors
Inspector
STORM DRAIN FEE
MISC
Date
Inspector
FINAL
Date
Date Inspector
PLUMBING & GAS
SIZE MATERIAL
SIZE MATERIAL
Date Inspector
APPLIANCE
TYPE OF APPLIANCE
UNITS
I �.
4
WATER SYSTEM
SIZE
TE
TOTAL FIXTURES
UNDER\GRblUND
REGISTERS
FIXTURE FEE
PARTIAL ROUGH
COMBUSTION VENT
Date
Inspector
MAIN DRAIN FEE
ROUGH COMPLETE
MISC
Do to
Inspector
STORM DRAIN FEE
MISC
MAIN DRAIN
GAS DRYER
Date
Inspector
WATER SYSTEM FEE
FLOOR FURNACE
GAS PIPING
TOTAL FEE
_C / Date
or
f
GAS PIPING FEE
� FINAL 6
Date
Inspector
PERMIT FEE
s2
MISC
Date
Inspector
TOTAL FEE
s `�
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