NO PERMIT NUMBER za eifz I ,�/ Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO q
File No.� 100/
i
//-- Sanitary No.
Date � 196 �G1�
Applicati is .reby made for a permit to
_a - story, Type
to be occupied only as
in accordance with Plot Plan, Plans and Specification filed herewith.
Estimated Value of Improvements $
FEESPlan Check b
n
Ower L ae Address
Contr. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 5S 196 FEES T 1:2-v.
Contr. J Address SGJ 4&:e_�d r
Phone State License Arflo 6 j
Approved A:M40 /1' 4
APPLICATION FOR PLUMBING & GAS PERMIT (��L
Date 196 GAS FEE $
PLUMBING FEE $
Contr. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEES
C ontr. Address
Phone State License
Approved
Applicants agree not to violate arty of the
-
Workman'.s Compensation Laws of the
State of California
RECORD OF INSPECTION APPROVALS
FOUNDATION BUILDING
Date Inspector
UNDERFLOOR
FRAME
Dar Inspector
a e Inspector
LATH & PLASTER
t
FINAL Inspector
D to Insoector
ELECTRICAL
,OUTLETS
SERVICE SIZE
SWITCHES .UNDERGROUND
RECEPTACLES ROUGHWIRING Date Inspector
Date Inspector
FIXTURES FINISH WIRING
Date ns pacror
H , CH FIXTURES
Date nspector ,
PERMIT FEE Motors
t Ins pa ctor
TOTAL-FEES FINAL
to / Inspector
PLUMBING & GAS '
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE TERIAL
WATER SYSTEM SIZE ITERIAL
TOTAL FIXTURES . UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date -Inspector
MAIN DRAIN FEE ROUGH COMPLETE
STORM DRAIN FEE MAIN DRAIN Do to Inspector
WATER SYSTEM FEE GAS PIPING Date Inspector
Date Inspector
GAS PIPING FEE FINAL
PERMIT FEE MISC Date Inspector
Date Inspector
TOTAL FEE MISC
Dote 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 Ins pastor