NO PERMIT NUMBER (2)/0 3 Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No.
Sanitary No.
Data 196
Application is hereb ade fora permit to
story, Type
to be occupied out ns
in accordance Plot Plof, Plans anti Specification filed herewith,
Est mato Value of Improvements $
FEE$ Plan Check $
Owner `/A,i Address .'Ll ! CL-C
Cont'. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Data 196 FEE$
Cont,. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date yZ 196 GAS FEE $
PLUMBING
i FEE
c $
,. /4/ r� Address ✓2O 1 149;' — 4!&&
Phone a ! • 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 Lmus 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 insoector
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 SIZE TERIAL
WATER SYSTEM SIZE JAIERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
MAIN DRAIN FEEROUGH COMPLETE Date Inspector
Do to In pe ctor
STORM DRAIN FEE MAIN DRAIN lot
afe ector
WATER SYSTEM FEE GAS PIPING/
or
GAS PIPING FEE FINAL
Date n ctor
PERMIT FEE �` MISC
Data Ins pactor
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
Data Inspector