51067 ,C� " � �
e2G9L I E W Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
C3�3i File No.
Sanitary No.
Date 196
Application is hereby made for a permit to
u story, Type
to be occupied only as
in accordance with Plot Plan, Plans and Specification filed herewith„
Estimated Value of Improvements $
FEES Plan Check $
Owner 6�ddrass
Contr. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date x;196 FEES,
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date�a - 196 t GAS FEE $
PLUMBING FEE $
Contr. Q Address' iz�i
Phone t+ State License 1.7-2 �� y
Approved
APPLICATION FOR APPLIANCE PERMIT
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
PPROVALS -FOUNDATION BUILDING
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Dote Inspector
LATH & PLASTER
Data Inspector
FINAL
Date Insoectar
ELECTRICAL
,OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
RECEPTACLES ROUGH WIRING Date Inspector
FIXTURES FINISH WIRING Dote Inspector
H.P. CHARGE FIXTURES Date Inspector
Date Inspector
PERMIT FEE Motors '
Date Inspector
TOTAL FEES FINAL
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE JIWTERIAL
WATER SYSTEM SIZE IATERIAL
TOTAL FIXTURES . UNDERGROUND
FIXTURE FEE PARTIAL ROUGH -&e
Date 0'1Inspector
MAIN DRAIN FEE ROUGH COMPLETE
ate for
STORM DRAIN FEE MAIN DRAIN -I' C
Date Inspector
WATER SYSTEM FEE GAS PIPING
Date Inspector
GAS PIPING FEE FINAL
Date Inspector
PERMIT FEE MISC
Dote Inspector
TOTAL FEE MISC -
Date Inspector
APPLIANCE
TYPE OF APPLIANCEUNITS 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
' h0. xer
® IALQN FOR PLUMBING PERMIT
Y OF CU� $TFNO
M c ' Sanitary Teti �yast�
LL / 7
o Unt 19 _ Permit No '� O �'
LL C�,TY QF �,UPE( TJQ P�s L4.(- It=
o pplica ion is crebX a the City of Cupertino for a permit Lo install plumbing
% pipes and/ur fixtures fisted on the reverse side hereof, and agrees to install said rrirca
a and/or fixtures in accordance with the provisions of the Plumbing Code of the Carty of
i W Cupertino, and all Other -a applica hereto.
W = `
Ff
j LL Use of Premises
00 J
S< O er A
zAdd
0 ALTOx,AGBr
3 �
—0 on
u QiQ tate'Liecjf7��lJ APprove �C
U / PLUMBING IMPBCrOR
p
a
Bldg." DI,k
Offke Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUP17RTINO
Sewer Connection Sanitary Permit No- ----e .X/------------
[g/Plumbing Final Plumbing Permit No. s--5-/Q6.7.......
LotNo. ................................
Owner or Tenant —1 ------ ----- ----- ----
. .................. ......... .....
... ... ...
At ...co�� -- ----
...
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.Tract ................. ....................................... ...... .......................................... ........................
Date'Connected -------------------------- ----------- - ------------ --------------------- 19-��
Date
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DateFinal ................ .................. ----------------------I---------------------------------
.............................
PLUMBING INSPECTOR
III 7/63-IM