NO PERMIT NUMBER Q J ? //�fyn
A64-ut .✓ Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
Sanitary No. �j
/
File N6/40a
t7� 3a
Date 1_196 7
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 $
p 0
FEE$ O Plan Check $
Owrmr Address
Contr. Address / 0 2"1 a.,
Phone S� .s 3� State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEES
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Data 196 GAS FEE S
PLUMBING FEE $
Cont'. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEE$
Cont,. Address
Phone State License
Approved
Applicants agree not to violate any of the
61orknuinrs Compensation Latus of the
State of California
RECORD OF INSPECTION APPROVALS
BUILDING
DATE INSPECTOR MISC.
PAD FINAL
FOUNDATION
UNDERFLOOR
FRAME
LATH & PLASTER
GRADING FINAL
FINAL BLDG.
ELECTRICAL
DATE S EQTOR A. MISC.
hf
UNDERGROUND ROUGR' -
ROUGH WIRING
FINISHED WIRING
FIXTURES
MOTORS
FINAL 71
PLUMBING, GAS 8 APPLIANCE
DATE INSPECTOR MISC.
BACK FLOW REO.
SANITARY NO.
UNDERGROUND ROUGH
PARTIAL ROUGH
ROUGH COMPLETE
MAIN DRAIN
FINAL PLBG.
FINAL GAS
FINAL APPLIANCE
DATE INSPECTOR MISC.
MISC
MISC
MISC