NO PERMIT NUMBER (2) Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File ....r/ora
Sanitary No.
Data 196
Appli coli is hereby mad or a perm
a story, Type
to be occupied only as
m u .ordance wi lot Ian, Plans and Specification filed heretuitk
Estima d Valve of Improvements $
FEES �® Plan Check $
Owner �"�����L./i.{Jsrs�.�✓Address
Contr. Address
Phone State License
Approved
L
APPLICATION FOR ELECTRICAL PERMIT
Data 196 FEES
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date ?•' �' • 196 GAS FEE S
//�
L PLUMBING FEE $
Cdntr. r�`I ddress 33 01 YJ�.[Glda�
Phone 022Q(V -.'30 442 State License ./
Approved Z z -rte
APPLICATION FOR APPLIANCE PERMIT V�1
Date 196 FEES
Contr. Address
Phone State License
Approved
Applicants agree not to violate any of the
Workman's Compensation Laws of the
State of California
RECORD OF INSPECTION APPROVALS
FOUNDATION BUILDING
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Date Inspector
LATH & PLASTER
Date Inspector
FINAL
Date Ins Doctor
ELECTRICAL
,OUTLETS SERVICE SIZE
SWITCHES UNDERGROUND
-RECEPTACLES ROUGH WIRING Date Inspector
FIXTURES FINISH WIRING Date Inspector
H,P: CHARGE FIXTURES Date Inspector
Date Inspector
PERMIT FEE Motors
'
TOTAL FEES FINAL Date Inspector
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE I I MATERIAL
STORM DRAIN I SIZE I L016TERIAL
WATER SYSTEM SIZE ATERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Date nspector
STORM DRAIN FEE MAIN DRAIN
Date bwect.or
WATER SYSTEM FEE GAS PIPINeil
e I Ctorr:::
GAS PIPING FEE FINALDate Ins
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 MISC
GAS RANGE MISC
GAS DRYER PERMIT FEE
FLOOR FURNACE TOTAL FEE
INSPECTED
Date Inspector