NO PERMIT NUMBER i
Z0 S s ��I C4- / `-IO'Q!r /�+�/�, Lot No.
No. Street
APPLICATION'FOR BUILDING PERMIT
CITY OF CUPERTINO
Sanitary No.
File No.'rx--a j
Date D 196
Application is hereby made for a permit to
nstory, ype
to be occupied only as
in accordance with Plot Plan, Plans and Spec' ication filed herewith,
Estimated Value of Improvements $
N
FEES � '� Plan Check $
Owner .B Address ./
Contr. Address
Phone State License
Approved �/ 6
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Dote 196 GAS FEE $
PLUMBING FEE $
Contr. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEES
Cont'. Address
Phone State License
Approved
Applicants agree not to violate nay of the
Workman's Compensation Lams of the
State; of California
RECORD OF INSPCTION APPROVALS
BUILDING
DATE INSPECTOR MISC.
PAD FINAL
FOUNDATION
UNDERFLOOR
FRAME
LATH & PLASTER
GRADING FINAL
FINAL BLDG.
ELECTRICAL
DATE INSPECTOR MISC.
UNDERGROUND ROUGH
ROUGH WIRING
FINISHED WIRING
FIXTURES
MOTORS
FINAL
PLUMBING, GAS & APPLIANCE
DATE INSPECTOR MISC.
BACK FLOW REQ.
SANITARY NO.
UNDERGROUND ROUGH
PARTIAL ROUGH
ROUGH COMPLETE
MAIN DRAIN
FINAL P
AL GAS
FINAL APPLIANCE 0 D
DATE INSPECTOR MISC.
MISC
MISC 1
MISC
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t�0'� STREET �/ flLOT NO,
APPLICATION FOR APPLIANCE PERMIT
w = ® ® CITY OF CUPERTINO
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3 a D._[e I by i7 I 196E Permit No.
w 231 / Fee $
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� A>>lication is hereby ntArle to the City of Cupertino for a permit to
o a CITiVst k as EiRTNbbsted on the reverse side hereof, and agrees to
i(n install said appliances in accordance with the provisions of the Plumbing
� i Codc of the City, Cuper 'no, and all other laws applicable thereto.
4 ,�, Use of Premises // N�'n�°��
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3.O C T ACTOR, G T
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o i State License Approved 0"
PLUMBING 0
(/ PLUMBING INSPECTOR
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