NO PERMIT NUMBER .nW467.. A.,
19M Let No. 2 I
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No. �d � 7
Sanitary No.
Date 196
Application is hereby made for a permit to
a story, Type
to be occupied only as
in accordance with Plot Plan, Plans and Specification filed herewith.,
Estimated Value of Improvements $
FEE$ Plan Check $
Owr.er Address
Contr. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
Contr. Address
phone State License
Approved
APPLICATION FOR'PLUMBING & GAS PERMIT
Date 196 4' GAS FEE $
PLUMBING FEF $
Contr. Address 7.i
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Dote 196 FEE$
Contr. Address
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
Date Inspector
LATH & PLASTER
Data Inspector
FINAL
Date Inspector
ELECTRICAL
.OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
Data Inspector
RECEPTACLES ROUGH WIRING
Date Inspector
FIXTURES FINISH WIRING
Date Inspector
H.P. CHARGE FIXTURES
Date Inspector
PERMIT FEE Motors
Date Inspector
TOTAL FEES FINAL
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE I I MATERIAL
STORM DRAIN I SIZE I L6,16TERIAL
WATER SYSTEM SIZE ITERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Dote Inspector
STORM DRAIN FEE MAIN DRAIN
Date Inspector
WATER SYSTEM FEE GAS PIPING
GAS PIPING FEE FINAL —�/��` Date s r
Date Spector
PERMIT FEE MISC
Date Inspector
TOTAL FEE MISC
Data 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