FILE 51037Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
.. File No. /V
Sanitary No.
Date 196
Application is hereby 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 $
FEE$ Plan Check $ f"y'
Owner j4 .�(//� Address
Contr. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196
FEE$
Contra
Address
Phone
State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT .
�Q
Date 196
GAS FEE $
PLUMBING FEE $
7C�-
Contr.
Address
Q
*20 4e�Jo
Phone t2
State License
t Approved (ti&Z 4�0 0( ie—e
APPLICATION FOR APPLIANCE PERMIT /
Data 196
- FEE$
Contr.
Address
Phone
State License
`
'Approved
Applicants agree not to violate any of the
Workman's Compensation latus of the
State of California 'i
RECORD OF INSPECTION
APPROVALS
I I MATERIAL
FOUNDATION
STORM DRAIN
BUILDING
'
FIXTURE FEE
RECEPTACLES
PARTIAL ROUGH
FIXTURES
Date
Date
-
Inspector
UNDERFLOOR
PERMIT FEE
TOTAL FEES
Data
Inspector
Date
FRAME
MAIN DRAIN
MISC
`
Date
Inspector
WATER SYSTEM FEE
PERMITFEE
GAS PIPING
FLOOR FURNACE
Date
Date
Ins pector
LATH & PLASTER
FINAL
Inspector
Date
FINAL
.2�
MISC
Date
Inspector
TOTAL FEE
Date
Ins oec for
ELECTRICAL
UNDERGROUND
ROUGH WIRING.
FINISH WIRING—
FIXTURES
SERVICE
IRING_FIXTURES
Motors
FINAL
SERVICE SIZE
Date Inspector
Date Inspector
Date Inspector
Date
Date
Inspector
Inspector
Date _ Inspector
PLUMBING & GAS
MAIN DRAIN
I SIZE
I I MATERIAL
,OUTLETS
STORM DRAIN
I SIZE
SWITCHES
FIXTURE FEE
RECEPTACLES
PARTIAL ROUGH
FIXTURES
Date
M.P. CHARGE
MAIN DRAIN FEE
PERMIT FEE
TOTAL FEES
Data
Inspector
UNDERGROUND
ROUGH WIRING.
FINISH WIRING—
FIXTURES
SERVICE
IRING_FIXTURES
Motors
FINAL
SERVICE SIZE
Date Inspector
Date Inspector
Date Inspector
Date
Date
Inspector
Inspector
Date _ Inspector
PLUMBING & GAS
MAIN DRAIN
I SIZE
I I MATERIAL
TYPE OF APPLIANCE
STORM DRAIN
I SIZE
I lmd,6TERIAL
WATER SYSTEM
I SIZE
ATERIAL
TYPE OF APPLIANCE
TOTAL FIXTURES.
FEE
UNDERGROUND
FIXTURE FEE
REGISTERS
PARTIAL ROUGH
BLOWER FURNACES
Date
Inspector
MAIN DRAIN FEE
ROUGH COMPLETE
MISC
Data
Inspector
STORM DRAIN FEE
MAIN DRAIN
MISC
`
Date
Inspector
WATER SYSTEM FEE
PERMITFEE
GAS PIPING
FLOOR FURNACE
Date
Inspector
GAS PIPING FEE
FINAL
Date
Inspector
PERMIT FEE
.2�
MISC
Date
Inspector
TOTAL FEE
MISC
Vote 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 -
PERMITFEE
FLOOR FURNACE
TOTAL FEE
INSPECTED
Data
Inspector