FILE 100,043 //Y-;Zj / • 1. �/�, Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
/ CITY OF CUPERTINO
• Fiie NoAod'ok O
Ar
Sanitary No.
Date 196
Application is hereby ma fora permit to
a story, Type
to be occupied only a.
.cordan • with Plot plan, Plans and Specification filed herewith,
"t
Estimated`Volue of Improvements $
FEES Plan Check $
Owner Address
.
Contr. Address
Phone State License
Approved
a
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEES
Cont,. Address
Phone State License
Approved
APPLICATION FOR PLUMBING aL GAS PERMIT
Date 196 1 GAS FEE $
PLUMBING FEE $/
Contr. /' Address /
✓//
Phone oZO I/i� �'— 2;z State License
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
_1
RECORD OF INSPECTION APPROVALS
FOUNDATION BUILDING
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Date Inspector
LATH & PLASTER
FINAL Date Inspector
Date Ins oe ctor
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 I LALTERIAL
r
WATER SYSTEM SIZE I 4TERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE ✓ PARTIAL ROUGH
' Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Date Inspector
STORM DRAIN FEE MAIN DRAIN
Date Inspector
WATER SYSTEM FEE GAS PIPING
Date Inspector
GAS PIPING FEE FINAL
Date Inspector
PERMIT FEE � MISC
Date Inspector
TOTAL FEE - dZ 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
Date Inspector _