NO PERMIT NUMBER�t���Q I /�^�✓s.f�Lsti,/ a`-'„-^i Lot No.
No. Street f
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No.
Sanitary No.
Dare 196 G
App i tion is hereby made far¢ mi to
story, Type
to be occupied on Ly ns
in accorda .e with Plot Plan, Plans and Specification filed herewith.
Estimated Value of Improvements $
FEES Plan Check b
Owoer I"' Address
Contr. Address
Phone Store License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEES
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date / 196 GAS FEE $
PLUMBING FEE $
C ontr. L Address ad's /-S' p �^^ l—
.21 - 133.G
Phone 5Stara License /fj 91C L
Approved a
APPLICATION FOR APPLIANCE VERMIT
Dote 196 FEES
Contr. Address
Phone 1e State License
� t Approved
Applicants agree not to violate any of the
Norkrrwn's C.nmpensation Laws of the
State of California
RECORD OF INSPECTION APPROVALS
FOUNDATION BUILDING
Dote Inspector
UNDERFLOOR -
Date Inspector
FRAME
Date Inspector
LATH 8 PLASTER
Date - Inspector
FINAL
Date Inspector
ELECTRICAL
.OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
Date Inspector
FIXTURES. FINISH WIRING
N.P. CHARGE FIXTURES Date Inspector
Date Inspector
PERMIT FEE Motors
Date Inspector
TOTAL FEES FINAL
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
t:
STORM DRAIN SIZE MATERIAL
WATER SYSTEM SIZE ITE.RIAL
TOTAL FIXTURES 71519!� UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Dote Inspector
MAIN DRAIN FEE o2 dam- ROUGH COMPLETE
STORM DRAIN FEE MAIN DRAIN
- 1
Data 77nspector
WATER SYSTEM FEE G S PING
r rc — D !lp3,p e
GAS PIPING FEE AL
Llnk6ector
PERMIT FEE
Date InspectoK
TOTAL FEE 'ry I S C
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
.Bldg. Dept
I Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
Sewer Connection Sanitary Permit No: --- -----------
Plumbing Final Plumbing Permit ----------
LotNo. ------------------------
......................
Owner or Tenant -------------------.........................
---------------------------------
Tract .................................................—.=........ ............................... .................................
Date Connected ............................/ ------------
--------- ...... ........... .......-------- .
DateFinal ................................. ..................................................... .
.......... ..................
.4 PLUM ING INSPECTOR
III 7/63-IM