FILE 51064No.
Street
Lot No.
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No.
Sanitary No.
a
Date 2196 l�
Applicakon/is hereby made for a permit to ,T
a story, Type Jr—
! 1 17
to be occupied only as
in aceordanllwith Plot Plan, Plans and Specification filed herewith,
.}Estimated Value of Improve mant's $,
FEE$ - 7�0�'- � � �% Plan Check $ d , /
Owner
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Contr. Sirs ' i Address }--
Phone c'Z t5' 3-7 State License ��7 2 -7
Approve
Ro-ed
APPLICATION FOR ELECTRICAL PERMIT
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Date ?' L 196 �- FEES /J
Contr. ..--2-� Address /7Js�IZI��'� fu -11Ce%.
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ph. State License
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Approved
Approved WILLIAM D. 0EP17V.1CH
Applicants agree not to violate any of the
Workman's Compensation Laws of the
State of California
APPLICATION FOR; PLUMBING & GAS PERMIT
Data
196 �� GAS FEE
PLUMBING FEE
$ �d
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Contr.
Address A6
Ids
Phone
`-"� t'• -��� State License
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Approved -Agtll-LIAM
D. OnENEVICH
A6PPL A�TJI/ON/FOR PyER
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MIT
Dote
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�FEEf�IANCE
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Contr.
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Phone
� �- °� State License �� //c JV- > k,
Approved WILLIAM D. 0EP17V.1CH
Applicants agree not to violate any of the
Workman's Compensation Laws of the
State of California
s
RECORD OF INSPECTION. APPROVALS
FOUNDATION - BUILDING
` c� y
UNDERFLOOR
FRAME - b <✓"'L��i�
Do
te
ATH PLASTER
FINAL
Date l/
ELECTRICAL
I"ns pe c for
Ins De ctor
SWITCHES ;1
3
UNDERGROUND
SERVICE SIZE
STORM DRAIN 61
SIZE
TERIAL
2
3
/
PARTIAL.ROUG ".9-L�S'
MAIN DRAIN FEE
actor
RECEPTACLE
STORM DRAIN FEE -'
ROUGH WIRING
— - J7
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D
Data
GAS PIPING FEE
Inspector
FIXTURES'
PERMIT FEE
FINISH WIRING
nspector
MISC
O
H.P. CHARGE
5V
FIXTURES
Date
2'
Inspector
PERMIT FEE
�
I
Motors
Date
Inspector
FEES
/
s' WS
D to
`-
actor
TOTAL
FINAL -
Data
Inspector
PLUMBING & GAS
MAIN DRAIN
SIZE
I MATERIAL
TYPE OF APPLIANCE
STORM DRAIN 61
SIZE
TERIAL
FIXTURE FEE
WATER SYSTEM
I SIZE
TERIAL
TYPE OF APPLIANCE
TOTAL FIXTURES,
FEE
UNDERGROUND
FIXTURE FEE
/
PARTIAL.ROUG ".9-L�S'
MAIN DRAIN FEE
02-`'�
Date r
ROUGH COMP LET
STORM DRAIN FEE -'
��-
Dat
MAIN DRAIN 6-
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WATER SYSTEM FEE
GAS PIPING J
GAS PIPING FEE
FINAL G^!_LDate p r
(DJ'Date
PERMIT FEE
nspector
MISC
ate Inspector
TOTAL FEE �
17e
MISC
Date Inspector
APPLIANCE
TYPE OF APPLIANCE
UNITS
FEE
TYPE OF APPLIANCE
UNITS
FEE
CIRCULATING HEATERS
REGISTERS /-4//
3 3-0
BLOWER FURNACES
��-
COMBUSTION VENT
SUSPENDED UNIT
MISC
GAS RANGE
MISC
GAS DRYER
PERMIT FEE
2'
FLOOR FURNACE
TOTAL FEE
J'7
INSPECTED 42'(n'I�J� «•�
Date spector
( FsIC(ECOPY
To
You are I
Owner or Ten,
At ...__CQ.i
No. of Wires
ELECTRIC SERVICE NOTICE '
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
_.....-----._..., �... ....: _....... . 196..5
Size of Wires
Motor Load ------------------------- Voltage ------------- .................. Phase
HeatingLoad ........................ K. W. --------------------------------- Voltage
i
Light ............... 110............ New Se ce....... ...
No. of Meters...................
Heat._. ......... Threeire::.J.......;
No. of Add. Meters............ ae��//11
Power .............. T as ....::..
ELECTRICAL 'ID
104 7/63-500
Service_..........
Meter.. ..._----
State
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FIXTURES NUMBER
MAIN DRAIN
UNRS FEES
IUNITSI FEES
Water Hcater
I Size
Water Closets
Material �
Bath Tubs
To Curb
Showers
To Prop., Line
Lavatories ,3 ��
To Existing
Kitchen Sinks
Not Conn.
Dish Washers NL
Waste Disposals Iris-
_
Wash Trays
STORM DRAINAGE
Washing Machines J - �I
Size
Water Softeners
Material
Bar Sinks
To Main Drain _
Comb. Sink & Traysi
To Curb
Dental Units
Drinking.Fount 'nsi .1
Floor Drains
WATER SYSTEM
Hoppers
Size
Restaurant Sinks
Material '
Sand Traps �
L
TOTAL FEES
Urinals
Fixture Fee /
Area Drains
Main Drain Fee
Water Leaders
Storm Drain Fee.
Sprinkler Vawes
Sr
Water Sys. Fee
Permit Fee
TOTAL //
TOTAL VEE
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final
I AGREE I WILL NOT VIOLATE ANY OF THE WORKMEN S
COMPENSATION LAWS OF THE STATE OF CALIFORNIA.
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I AGREE I WILL NOT VIOLATE ANY OF THE WORKMEN'S
COMPENSATION LAWS OF THE STATE OF CALIFORNIA. /v
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NAME TYPE
HOUSE GAS PIPING
Number of Outlets c2 Size of Main 13�,
Gas Piping Fees
Tested and Approved ........ . ........................._..................
DATE INSPECTOR
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Type of Appliance Units Fees I
Remarks (Check ✓) .
New, Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates��
Circulating Heaters
Blower Furnaces l l . n6
X
Gas Fired Boilers �• ��
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Warming Ovens
Percolators
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Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
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Floor Furnace
Miscellaneous
NAME TYPE) .I
Fee I2.0(�
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pp ;ance Fees —7-1-1K0)11
Inspected and Approved ........... ...............................................
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