NO PERMIT NUMBER (2) Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
Sanitary No.
j File No.
Dote 196
Application is hereby made for pern�a
Type
.. to beoccupied only as
.... ., in accordance with Plot Plan, Plans and Specification filed herewith„
�f Estimated Value of Improvements $
FEES • Oy Plan Check $
Owner Address
Contr. Address
Phone eZS � ��� State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date 196 GAS FEE $
PLUMBING FEE $
Contr. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEES
Contr. Address"
Phone State License
Approved
Applicants agree not to violate any of the
Workmen's Compensation Laws of the
State of California
I
RECORD OF INSPECTION APPROVALS
BUILDING
DATE INSPECTOR MISC.
PAD-FINAL
FOUNDATION
,UNDERFLOOR
FRAME
LATH & PLASTER ..,
GRADING FINAL
FINAL BLDG.
ELECTRICAL
DATE INSPECTOR MISC.
I
UNDERGROUND ROUGH
ROUGH WIRING
FINISHED WIRING
FIXTURES
MOTORS
TINA 1
j
I
PLUMBING, GAS & APPLIANCE
DATE INSPECTOR MISC.
!,BACK FLOW REQ.
it
SANITARY NO.
UNDERGROUND ROUGH
i, PARTIAL ROUGH
I,
ROUGH COMPLETE
MAIN DRAIN
FINAL PLBG.
FINAL GAS
FINAL APPLIANCE
DATE INSPECTOR MISC.
MISC
MISC
MISC
Agizp IouIGA-40. COPA77 l
N Q NO, r STREET LOT NO,
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LL APPLICATION FOR ELECTRICAL PERMIT
3 a CITY OF CUPERTINO
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o Date ✓" 19' — Permit No.
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a Application is hereby made to the City of Cupertino for a permit to install electrical
W : wiring and/or fixtures as listed on the reverse side hereof, and agrees to install said
o 'o wiring and/or fixtures in accordance. with the provisions of the Electrical Code of the
S m City of Cupertino, and all other laws applicable thereto.
0i
z� Use of Premises
J ` 3/O�Ltir.A�.I,�t aT
3 Q
Owner -l� Address�—
W Z By —SAN Address
U a n CONTRACTOR, AGENT App
roved _.
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U Phnnc: a ELECrItICAL INS ao
State License
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