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NO PERMIT NUMBER //0Lot No. No. Street APPLICATION FOR BUILDING PERMIT CITY OF CUPERTINO File No. 'r1101 Sanitary No. Do to / 196 Ar Application is hereby made for a permit to J. a story, Type dl to be occupied only as in acccrdanre with Plot Plan, Plans and Specific on filed herewith, Estimated Value of Improvements s 3c 0 FEE$ �A4 JAA. s Plan Check $ Owner Contr. w {� Address Phone arA -.f 7� / State 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 $ Contr. Address Phone 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 Dare Ins pe ctor UNDERFLOOR Dare Inspector FRAME ate Inspector LATH 8 PLAST • AD Dat r FINAL I E ICAL ,OUTLETS SERVICE SIZE SWITCHES UNDERGROUND Date Inspector RECEPTACLES ROUGH WIRING ' FIXTURES FINISH WIRING Date Inspector H.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 TERIAL 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 Date Inspector. GAS PIPING FEE FINAL Date Inspector PERMIT FEE MISC Dote 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 Data Inspector