51114 /o a'A Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No.
/ Sanitary No.
Data / 3 196 6
plication is ereby ma# for a permit to
LCA a story, Type
to be occupied only as
in accordance with plot Plan, Plans and Specification filed herewith,
Estimated Value of Improvements $
FEES qq Plan Check $
Owner L/l �Q� — �� Address
Contr. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
Cont'. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date 3 196 GAS FEE $
PLUMBING FEE $ C9J
Contr. Address 3-Z) O^ a/�
Phone �rZp' S"U �� Stare License� /�f3}—`'/J2 A
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEES
Contr. Address
Phone State License
Approved
9pplicants agree not to violate any of the
Vorkman's Compensation Laws of the ,
itate of California
RECORD OF INSPECTION APPROVALS
BUILDING
FOUNDATION
Date Inspector
UNDERFLOOR
Data Inspector
FRAME —
Do to
RAMEDate Inspector
LATH & PLASTER
Data Inspector
FINAL
Data Ins oe c for
ELECTRICAL
,OUTLETS SERVICE SIZE
SWITCHES UNDERGROUND
Data Inspector
RECEPTACLES ROUGH WIRING
Data Inspector
FIXTURES FINISH WIRING
Data Inspector
H.P. CHARGE FIXTURES
Date Inspector
PERMIT FEE Motors
Date Inspector
TOTAL FEES FINAL
Data Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE MATERIAL
WATER SYSTEM SIZE IATERIAL
TOTAL FIXTURES .S"d UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Data Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Do td Inspector
STORM DRAIN FEE MAIN DRAIN
Data Inspector
WATER SYSTEM FEE GAS PIPING
Date Inspector
GAS PIPING FEE FINAL
Date Inspector
PERMIT FEE a'� 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
Dote Inspector
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