51037 1! 7J ^ I 6L/ Aa—Q Lot No.
No. Street —
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No. /02
C/ T' Sanir ? N
Dote 196
Appliga tion i ,eerre/by me a r a p r it to CI
I I a story, Type
to be occupi-on as
/ in accordance with Plot Plan, Plans and Specification filed herewith,
Estimated Value of Improvements $
FEE$ Plan Check $
Owner' �� Address
Contr. Address
Phone Stare License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Dara 196 FEE$
Contr. ' Address
Phone State License
Approved
oIdA`hbrP L ffj G & GAS PERMIT ft
Dote, 19�0 � GAS FEE $
PLUMBING FEE x —
� Address ��
/� p� ti
Conti.' "i'rr P
pho e
o29S- s" State Lice
W* Approved
APPLICATION FOR APPLIANCE PERMIT
Data 196 FEE$
Contra Address
Phone State License
Approved
Applicants agree not to violate any of the
Workman's Compeniation Laws of the
State of California '
RECORD OF INSPECTION APPROVALS
FOUNDATION BUILDING '
UNDERFLOOR Do to
Ins pe<tor
FRAME Date Inspector
LATH'& PLASTER Date Inspector
FINAL Date Inspector
Date Ins oe ctor
ELECTRICAL
,OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
RECEPTACLES ROUGH WIRING Data Inspector
Data Inspector
FIXTURES FINISH WIRING
Date Inspector
H.P. CHARGE FIXTURES
PERMIT FEE Motors Date Inspector
Date Inspector
TOTAL FEES FINAL
Dote Inspector
PLUMBING & GAS
MAIN DRAIN SIZ I MATERIAL
STORM DRAIN SIZE I L&ATERIAL
WATER SYSTEM SIZE MATERIAL
TOTAL FIXTURES . UNDERGROUND
FIXTURE FEE "— PARTIAL ROUGH
In
Date spector
MAIN DRAIN FEE ROUGH COMPLETE
STORM DRAIN FEE MAIN DRAIN Date Inspector
Date Inspector
WATER SYSTEM FEE GAS PIPING
GAS PIPING FEE FINAL Date Inspector
W
PERMIT FEE � - MISC Date Inspector
ate 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