NO PERMIT NUMBER /D � 0 I ^�—�:��/ ✓`+ Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No. �Ot)J / Od
Sanitary No.
Do to 196
Application is barely mad ora ermit to
story, Type
to be occupied only as
in accordance with Plot Plan, Plans and Specification filed herewith,
Estimated Value of Improvements $
FEE$ Plan Check $
Owner • Address
Contr. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
Contr, Address
Phone $tate License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date 196 GAS FEE $
PLUMBING FEE $
Contr. Address
Phone State License
Approved
APPLI CATION FOR APPLIANCE PERMITs4, �
Date 9/� 196 _ tom/,, 7J'FEQES // `a "�(p
Contr. / / "`�""Y13dra ss d "�"'� /`-'
Phone 2:zz I ro 9G (a State License
" t/'i�- i
An agree not to violate any of the
App roved
Workman's Compensation Laws of the
State of California
__ r
/ 3
RECORD OF INSPECTION APPROVALS
BUILDING
FOUNDATION
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Date Inspector
LATH & PLASTER
Date Inspector'
FINAL
Date Ins as ctor
ELECTRICAL
,OUTLETS
SERVICE SIZE ,
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 & 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 GAS PIPING
Data Inspector
GAS PIPING FEE FINAL
Date Inspector
PERMIT FEE MISC
Date Inspector
TOTAL FEE - MISC
Data Inspector
APPLIANCE
TYPE OF tZ PLIANCE UNITS FEE TYPE OF APPLIANCE UNITS FEE
CIRCULATING HEATERS O� REGISTERS
BLOWER FURNACES COMBUSTION VENT / 00
SUSPENDED UNIT MISC
GAS RANGE MISC
GAS DRYER .PERMIT FEE Cid v
FLOOR FURNACE TOTAL
INSPECTED "-
n_... `� Ine neetm
c _ ro
OIL
to
T