NO PERMIT NUMBER ZC ';3s� ^� Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No
Sanitary No.
Date /a �y 196
Applicatis eby made for a permit to
story, Type
to he occupied only as
in accordance with Plot Plan, Plans and Specification filed herewith.
Estimated Value of Improvements $
FEES Plan Check $
Owrmr '//M�lw/ Address
Contr. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date �� 196FEES Y
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Data 196 GAS FEE $
PLUMBING FEE $
Contr. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Data 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
BUILDING
FOUNDATION _
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Date Inspector
LATH 8 PLASTER
Date Inspector
FINAL
Do to Ins as c tar
ELECTRICAL
,OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES OUGH WlI NG
Date Inspector
� FIXTURES NG
Date Inspector
M.P. CHARGE I T
Dafa Inspectoi'
PERMIT FEE tors
' Data Inspector
TOTAL FEES FINAL
Date Inspector
assesses
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE MATERIAL
WATER SYSTEM SIZE ITERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Dale Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Data 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 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
rt„t. Inspector
OFFICE COPY
ELECTKIC
AIVICE NOTICE
BUILDING INSPECTOR'S OFFICE
CITY 'OF CUPERTINO
.....'Y Y . . 194
.. .
..........7.......... .... ........ -----
TO
or
You are here author ed o.con ct lectrical iF
Owner or Tens .... . ... ............ ........
... ...............*...... ......... ..
At ......
............................ .......... . .......
i.......A.-.�
No. of Wires .........:.............. Size of Wires ............... ....... Size of Switch t 00
MotorLoad .......................... Voltage ................................ Phase' .................... .......
HeatingLoad ........................ K. W. ..... ............................ Voltage ------- ...................
h
N.o. of MetersLig' 110.:......... New Service................ Reconnect. .........
N6.of Add. 220..:........ Three i ............... Move Service............
Power.............. . . ......... MoveNete r..............
........... ..... ......... .... ....... .. . . . .
SL CAL INSP OR . . . .