NO PERMIT NUMBER/a L _ Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF.CUPERTINO
File No.
Sanitary No.
w
Date 196
r
Applicat' 's hereby made f r a pet
ry, Type
to be occupied only as
in a Gordan rc with Plot Plan, Plans and Specification filed herewith.,
Estimated Value of Improvements $
FEE$ � /J A^/ /f Plan Check E
Ow r.er ^tw'a�.�s� 0&24.4 ( Address
Contr. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Data 196 7 FEES
Address
Phone —7rji—ifZ 7 State License
Approved /
APPLICATION FOR PLUMBING & GAS PERMIT
Date 196 GAS FEE $
PLUMBING FEE E
Contr. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEES
Contr. Address
i
Phone State License
Approved
Applicants agree not to violate any of the
Workmen's Compensation Laws of the
State of California
RECORD OF INSPECTION APPROVALS
FOUNDATION 'BUILDING
Date Inspector
UNDERFLOOR _
Date Inspector
FRAME
Dote I ns pe c for -
LATH & PLASTER
Date Inspector
FINAL
- - Date Insoector
ELECTRICAL
.OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
RECEPTACLES ROUGH WIRING Date Inspector
FIXTURES FINISH WIRING Date Inspector
H.P. CHARGE A FIXTURES Date Inspector
Date Inspector
PERMIT FE Mors
TOTAL FEE ✓ '� Inspector
AL
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE MATERIAL
WATER SYSTEM SIZE I— ATERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Do to Inspector
STORM DRAIN FEE MAIN DRAIN
Date Inspector
WATER SYSTEM FEE GAS PIPING
Date Inspector
GAS PIPING FEE FINAL
Date Inspector
PERMIT FEE MISC
Date 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. YMISC
GAS RANGE `MISC
\t
GAS DRYER PERMIT FEE
FLOOR FURNACE TOTAL FEE
INSPECTED
Dote h Inspector
Vo302 L.os :.? .45 4.4 S/
NO. STREET LOT NO.
N Q
0 -,,APPLICATION FOR ELECTRICAL PERMIT
0 0 I'/ G�a� '�^ IT t OF CUPCRTINO
a
Wu (SEP 8 1967
o Date 195— Permit No. `� O
LL W T
o a ► 1 ! -� Fee ;i 3 'L
a Application is hereby madelto,the Gty of Cupertino for a permit to install electrical
w = wiring and/or fixtures as listed on the reverse side hereof, and agrees to install said
F M
00 wiring and/or fixtures in accord:uve with the provisions of the Electrical Code of the
5 0 City of Cupertino, and all other lass applicable thereto.
. 3
oa
z _j Use of Premises _
JZ
O
t� a Owner Po"qe n Address
N
W w By _ Address
CONTRACTOR, AGENT / 1
a 0 APprovedC�.
Phone: 2 5- 3 - 1`7 2 7 _ ELECMICAL INSPECTOR
4 State License;
i
NEW RPL FEES
Size Service Conduit Number of OuLlets
Size Service Wires Number of Switches "
Size Service Switch Number of Receptacles
Size Sub Feed Conduit Number of Fixtures
Size Sub Feed Wires Ranges KW
Number of Circuits Oven KW
Number of Meters Panels .Transformers
Signs
Misc. / _ Ihyers /
Motors HP Phase
Motors HP Phase
Motors HP Phase
Permit Fee 2.00
HP Charge
Total Fees 3