NO PERMIT NUMBER Y,...G►,� - Lot No.
No. Street
APPLICATION FOR BUILDING PE
CITY OF CUPERTTNO
File No. 's /Q
Sanitary No.
Date 196
Application i. �.. y ade for t to
a stay, Type
to be Occup .d y .c
in accordan a with Plot Plan, Plans and Specification filed herewith.
Estimated Value of Improvements $
FEE$ Plan Check $
Owner s • Address
Contr. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Data 196 FEE$
Contr. Address
Phone State License
� rl
® 1 Approved
JTL j9p BING & GAS PERMIT
Dore 196 GAS FEE $
TY Z UPE TiN _ PLUMBING FEE $
Contr. 2� /� a i ss 6" 7
Phone //� ' u �✓ Stat. License / A- e+ j4Q
Approved
APPLICATION FOR APPLIANCE PERMIT
Data 196 FEES
Contr. Address
Phone State License
Approved
Applicants agree not to violate any of the
Workmen's Compensation Lams of the
State of California
RECORD OF INSPECTION APPROVALS
FOUNDATION BUILDING -
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Do to Inspector
LATH & PLASTER
Date Inspector
FINAL
Date Insoector
ELECTRICAL
,OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
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 LA6TERIAL
WATER SYSTEM SIZE TERIAL
TOTAL FIXTURES . UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
STORM DRAIN FEE MAIN DRAIN Do to Inspector
fw Date Inspector
o WATER SYSTEM FEE GAS PIPING
GAS PIPING FEE FINAL Date Inspector
Date Inspector
PERMIT FEE j e MISC
Dote Inspector
TOTAL FEE p 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
Dote Inspector