NO PERMIT NUMBER Pp j c
O / I `� /!ia-t"L� Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No.
Sanitary No.
Do to Z/0 196
P licat' i re f permit to
a story, Type
tn'h ccupird Kly 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 State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Data 3/ 196 G GAS FEE $ fl-
PLUMBING FEE $ _
Carat. !/`+MP/ (/ 4�& "^`t Address
Phone "LL22 -asj G State License
_- , Approved
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEE$
Contr. 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
Date Inspector
FINAL
Date Ins oe c tar
ELECTRICAL
,OUTLETS SERVICE SIZE
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
Date Inspector
FIXTURES FINISH WIRING
H.P, CHARGE FIXTURES Date Inspector
Date Inspector
PERMIT FEE Motors
TOTAL FEES FINAL Date Inspector
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE I I MATERIAL
STORM DRAIN SIZE TERIAL
WATER SYSTEM SIZE 4TTERIAL
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
GAS PIPING FEE � da FINAL Date Inspector
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
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LOT NO.
NO. REE
FOR GAS PERMIT
za D
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0 , MAR 1( 1966
F O
Y
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3 a Date �����A 1119666 Permit No;
0 Ag1TYioAFheh'N)'tttatl@ J NP` Fee $ to
W LL
� ° Cny of Cupertino for a permit to install gas pipes
o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
i m and/or appliances in accordance with the provisions of the Plumbing Code of the City
z W of Cupertino, and all other laws applicable thereto.
W Use of Premises
00
o a
Owner� Le /Po 7-,f 4-I_V Address / 5/.jcFJ �iPY'�r 400e;;A
Wiz° By /V1 IV /iIS�A !/ l� " IN(''Address �/S /S 1JrFcleyf CpC.
3 CONTRACTOR, AGE `
— Phone. z 2 33l �✓
State License —3 01
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-y I PLUhfRf\C INSPECTO��