100,068 Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No/Od Q
Sanitary No.
Date 196
Application is hereby made for a permit to
a story, Type
to be occupied only as '
in accordance with plot Plan, Plans and Specification filed herewith.,
Estimated Value of Improvements $
FEE$ - Plan Check $
Contr. Address
Phone . State License
Approved
' 3r-
1
APPLICATION FOR ELECTRICAL PERMIT
Date /61 7 196 S FEE$ _ j o-0
E'r�sr C7�—"r"oa/ /A-�vC-t� Address 0 J_/ a
Phone __a2 S'o2 - (9 tq 9.r State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date 196 GAS FEE $
PLUMBING FEE $
Cont,, 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
Workman's Compensation Laws of the' '
State of California
RECORD OF INSPECTION ,APPROVALS
FOUNDATION - BUILDING
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Dote Inspector
LATH & PLASTER
Date - Inspector
FINAL
Date Ins oe ctor
ELECTRICAL
,OUTLETS SERVICE SIZE
SWITCHES UNDERGROUND
Date Inspector -
RECEPTACLES ROUGH WIRING
Data Inspector
FIXTURES FINISH WIRING
Date Inspector
H.P. CHARGE FIXTURES
Date Inspector -
PERMIT FEE Motors
D toeL
TOTAL FEES � FINAL "
Date
WeeNEI
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN I SIZE I LLATERIAL
WATER SYSTEM SIZE ITERIAL
TOTAL FIXTURES . UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date -Inspector
MAINDRAIN FEE ROUGH COMPLETE
.< .,
Date 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
Date Inspector