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Lot No.
No. Srreaf
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File Mo.O � Q�/
$anitary No.
Date 196
Applicotion is hereby mude for a permeG to
n story, Typa
tn 6r, nccupter!only ns
in �r.cordoncc u�ieh P1oC Plan, Plnns rsrtd Specifir,�tion filed herr.wieh,
Estimated Vol�e of Improvements E
FEES Plan Check b
Owner � i,/�O�C./.�✓ Address
Contr. Address
phonc Stote License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Dare �2 /6 196 s FEE$ � '3
Contr.t-/7"'"�"7��/ �/�'�'�/ Address �Q o d s
Phone ��� ��� � `� State License �_' � d V "'
Approved � i� "'w�� � -
APPLICATION FOR PLUMBING & GAS PERMIT
Doea 196 GAS FEE S
PLUMBING FEE $
Conrr. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Doro 196 FEE$
Conir. Address
Phone Sfate Licensc
Approved
�Ipplicants n�tae not !n violaec any nf the
!;'orkmm�'s Cnmpensa[inn /,aws of lAe
S2oee of Cn[ifomin
RECORD OF INSPECTION aPPROVALS
FOUNDATION BUILDING
Date Inspector
UNDERFLOOR
Dote Inspector
FRAME
Date Inspector
LATH 8 PLASTER �
Date Inspector
FINAL
Date Insoacter
ECECTRICAL
,OUTLETS
SERVIC� SV_E
SWITCHES UNDERGROUND
� Date Inspector
RECE TACLES ROUGH WIRING
Data �nspector
FIXTURE FINISH WIRING
QQ Data �nspector
H.P. CHARGE FIXTURES
Date specror
PERMIT FEE / O Motors
TOTAL FEE$ J 7 FINAI. ' �� Pector
9 te Inspect
PLUMBING & Ges
MAIN DRAIN SIZE MATERIAL
STORMDRAIN SIZE 'OTERIAL
WATER SYSTEM SIZE ,.,ATERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspecfor
MAIN DRAIN FEE ROUGH COMPLETE
DafA Inspactor
STORM DRAIN FEE MAIN DRAIN
Dare Inspector
WATER SYSTEM FEE GAS PIPING
Dote Inspactor
GAS PIPING FEE FINAL
Date inspector
PERMIT FEE MISC
Daee Inspaceor
�TOTAL FEE MISC
� Daea Inspecror
APPLIANCE
TYPE OF APP�IANCE UNITS FEE TYPE OF AppLIANCE UNITS FEE
CIRCU�ATING HEATERS REGISTERS
BLOWER FURNACES COMBUSTION VENT
SUSPENDED UNIT MISC
GAS RANGE MISC
GAS DRYER PERMIT FEE
FLOOR FURNACE TOTAL FEE
INSPECTED
Date Inspactor