NO PERMIT NUMBER s
/ I
/O God/ I �ilit.a...f./ Lot No.
No. Street I
I r
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No.
Sanitary No.
Date 9 yr 196 7
Application ' hereby made for a permit to
I- story, Type
to he occupied nn as
in accordance with Plot Plan, Plan and Specification filed herewith.
Estimated Value of Improvements $
FEE$ ,/ Plan Check $
Owner � g -/`"��u�� Address
Contr, Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
Contr. Address
PhoneState License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date .9 L6 196 7 GAS FEE $
�J PLUMBING FEE x
Contr. / Address '/
Phone State License/7/ x i
Approved
APPLICATION FOR APPLIANC PERMIT
Data 196 FEES
Cont', Address'
Q:
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
FRAME Date Inspector
Date Inspector
LATH & PLASTER
FINAL Date Inspector
Dote Insoector
ELECTRICAL
,OUTLETS
SWITCHES UNDERGROUND SERVICE SIZE
RECEPTACLES ROUGH WIRING Date Inspector
Date Inspector
FIXTURES FINISH WIRING
H.P, CHARGE FIXTURES Date Inspector
PERMIT FEE Motors Date Inspector
TOTAL FEES FINAL Date Inspector
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE MATERIAL
WATER SYSTEM SIZE ITERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
I
STORM DRAIN FEE MAIN DRAIN Date
Datensp ctor
WATER SYSTEM FEE G SPIPING
s f
GAS PIPING FEE Date or
Ins pactor
PERMIT FEE MISC Date
Date 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 j
GAS DRYER
PERMIT FEE '
FLOOR FURNACE TOTAL FEE
r �
INSPECTED r
Date Inspector
Bldg. Dept.
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CLJPERT�JNO
Sewer Connection Sanita;y Permit No. ...�
-----------------
VPlumbing Final Plumbing Permit No. -�6--------------1161
-- -------
Lot - --------------------------------
Owner or Tenant .......
..... - - - - ---------------------------------------
Aty.-------._..-------_--------------------------
Tract --------------------------
.................................................. ............................................................ ..
.......
Date Connected ........................ 7A40- ..-------------------------------------------------- 196;�p
PaleFinal --------------------------- ............................................................. 19A47-
----------------
P_LUMMG INSPECTOR
111 12/66-IM