NO PERMIT NUMBER _/�0 .�J O I `-'� �'�./ P"��a.uw.L/ Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No.
r
Sanitary No.
Date 196
pplication is hereby made for a permit to
i.✓ 10 .. ory, .Type
to be occupie only as I�►�/
in accordance with plot Plan, Plans and Specification filed herewith,
Estimated Value of Improvements §
e1
FEES - �' �� Plan Check $
Owner Addrpss
Contr. 1cG --o� K", b�t/�..J(dIl sj S q
Phone 7j 9 7 5; j' • , State License ? / 6 O
�
Approved /�/ 1
./ i
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
APPLICATION FOR APPLIANCE PERMIT
Date 1% FEES
Contr. Address
i
Phone State Licen e'f'
Approved I •`I
Applicants agree not to violate any of the'
Workman's Compensation Laws of the
State of California -
RECORD OF INSPECTION APPROVALS
FOUNDATION BUILDING -
Dote Inspector
UNDERFLOOR
Date Ins pe ctar
FRAME
Date Inspector
LATH 8 PLASTER
Date Inspector
FINAL
Dote Insoecter
ELECTRICAL
,OUTLETS SERVICE SIZE
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
Date Inspector
FIXTURES FINISH WIRING
M.P. CHARGE FIXTURES Date Inspector
Date Inspector
PERMIT FEE Motors
Date 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 GA (PING 19,
GAS PIPING FEE 1
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 _ , -- Y_ Inspector
/o S-. 'f I 'De .a.. �rr3
OT NO,
NO. STREET ..I
W L BUILDING PERMIT
Y ° F F.RTINO
C _
a p Sanitary No.
z o Dat /S P 196196 Pe it No.
o W Applicatjrber�y.rnalJf,�gl��e,�ni^'to
a N a story,Type V�Jf+ �IV Building
w
it,be occupied only as Id, in accordance with
o o Plans, Specifications and Plot-Plan filed herewith. PI Ck Fee
I_ ; Estimated Value of Improvements,$ e,7 7S'0 Fee$ 3
i J It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
* Z all other laws applicable to the construction, location, and use of buildings within the City of
0 Cupertino wi I bg complied with.
_ < Owner Address6i— !�
W a By Address ('3r1
` 0Phone 2127 Approved WII-I-• D• Br-WaVIGH
State License 3 S e n BUILDING INSPECTOR �