51009/03GQ I W Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
-Doe .ALL!--196��^—
Applicatiq is he 6y made for a permit to
I to be occupied only as
FEE$
Cont,.
Phone
File No.v 00
Sanitary No.
story, Type
in accordance with Plot Plan, Plans and Specification filed herewith,
Estimated Value of Improvements $
Plan Check $
Address
Address
State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Data 196 b FEE$
Cont-. Address %2 1y
'Phan, % ' / �� State License
.. .. Approved {..
APPLICATION FOR PLUMBING & GAS PERMIT
Data, 196
Contr.
Phone
Date
i.
Contr.
Phone
GAS FEE $ —
PLUMBING FEE $
Address
State License
Approved
-APPLICATION FOR APPLIANCE PERMIT
196 FEES
Address
State License
Approved _
Applicants agree not to violate any of the
Workman's Compensation Laws of the
State, of California
ELECTRICAL
SERVICE
,OUTLETS
TYPE OF APPLIANCE
SWITCHES.
FEE
RECEPTACLES
RECORD OF INSPECTION
Inspector
APPROVALS
ROUGH WIRING
TOTAL FEES
BUILDING
Inspector
FOUNDATION
Date
FINISH WIRING
Date
Do to
Inspector
Inspector
UNDERFLOOR
MAIN DRAIN
MISC
Inspector ,
Date
Motors
PERMIT FEE
Inspector
FRAME
[aat
spactor
a e
FINAL
GAS PIPING FEE
Do to
FINAL
V
I ns pector
LATH & PLASTER
Date
Inspector
PERMIT FEE
MISC
Date
Inspector
FINAL
TOTAL FEE
MISC
Date
Ins Dectnr
ELECTRICAL
SERVICE
,OUTLETS
TYPE OF APPLIANCE
SWITCHES.
FEE
RECEPTACLES
FIXTURES
Inspector
H.P. CHARGE
EE
ROUGH WIRING
TOTAL FEES
ELECTRICAL
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE MATERIAL
WATER SYSTEM
SERVICE
SIZE
TYPE OF APPLIANCE
TOTAL FIXTURES
FEE
UNDERGROUND
FIXTURE FEE
Inspector
Date
ROUGH WIRING
BLOWER FURNACES
Dote
Inspector
Inspector
Date
FINISH WIRING
MISC
Do to
Inspector
Date
FIXTURES
MAIN DRAIN
MISC
Inspector ,
Ott,
Motors
PERMIT FEE
GAS PIPING
FLOOR FURNACE
[aat
spactor
a e
FINAL
GAS PIPING FEE
FINAL
V
Inspector
Dote
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE MATERIAL
WATER SYSTEM
SIZE
TERIAL
TYPE OF APPLIANCE
TOTAL FIXTURES
FEE
UNDERGROUND
FIXTURE FEE
REGISTERS
PARTIAL ROUGH
BLOWER FURNACES
Dote
Inspector
MAIN DRAIN FEE
ROUGH COMPLETE
MISC
Do to
Inspector
STORM DRAIN FEE
MAIN DRAIN
MISC
Date
Inspector
WATER SYSTEM FEE
PERMIT FEE
GAS PIPING
FLOOR FURNACE
Date
Inspector
GAS PIPING FEE
FINAL
Date
Inspector
PERMIT FEE
MISC
Date
Inspector
TOTAL FEE
MISC
Uote 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
Data
Inspector
GLGV 11\IV JV•♦�•Vv
BUILDING INSPECTOR'S OFFICE
CITY OF CUP$j2TIN0 ._
To
You are hereby aut orizOd to
Owner or Ten t .`
�o
No. of Wires .......'.
Motor Load ............
Heating Load
for
Light ............... 110............
No. of Meters ...................
Heat ................ 220............
No, of Add. Meters............
Power ............... /
Reconnect ..................
Move Service...._......