NO PERMIT NUMBER QQ Lot No.
No. Street
APPLICATION FO BUILDING PERMIT
CITY OF CUPERTINO
Sanitary No.
/Q Ly O File No.
Dote 196
Application is hereby made for a permit to
oe a story, Type
to be occupied only as
in accordance with Plot Plan, Plan and Specification filed herewith,
Estimated Value of Improvements $
q •
FEE$, _...f� PIon Check $
Owner' Address
Contr. �^ Address
Phone _SOIL 4 State License Ilf -; ` Kf-07 T
Approved V ...
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEES
Contr, Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Dote 196 GAS FEE $
PLUMBING FEE $
Cont,. 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
n.
RECORD OF INSPECTION 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 8 APPLIANCE
DATE INSPECTOR MISC.
BACK FLOW REQ.
SANITARY NO.
UNDERGROUND ROUGH
PARTIAL ROUGH
ROUGH COMPLETE
MAIN DRAIN
FINAL PLBG. 76)
FINAL GAS
FINAL APPLIANCE
DATE INSPECTOR MISC.
MISC
MISC
MISC
1'.
l
Bldg. Dept.
• Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
Q Sewer Connection Sanitary Permit No. ...... r�8 ......
Plumbing Final Plumbing Permit No. ............................
LotNo. ................................
Owneror Tenant C.....-(X?�"r...r...................................................................
At ----fn--7c/f' � � r(�....1 !:. f ........................................................... ........--
Tract ---------------------------------- !-.-..-...--------------......---...__...---------......------..-..:._.---------------.
DateConnected ......e�n----- ............................................................... 19.--......--.
I
Date Final ............ -3-------- ------------------ 19........----
.......... .. ... ✓ :.��_:.. .........
PLUMBING INSPECTOR