51003 /Q J V7 T I �/L•A.I••tl/ Lot No.
No. Street -
CITY OF CUPERTINO
APPLICATION FOR BUILDING PERMIT
Sanitary No.
File No. 4220ed
Date 19
Application is hereby made for a permit to
story, Type
to be occupied only as
in act ante wit lot Plan, Plans and Specification filed herewith,
Estimated Value of Improvements $
FEE$ �^ _ n Plan Check $
Owner �o � - Address
Contr. ��"�"� �s+.�e✓ /�� C�e Address
Phone eZ A-..2 - .233 {• State License ��j`r��Qr���-
Approved �1
APPLICATION FOR ELECTRICAL PERMIT
Date 19 FEE$
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
ro
Dare yor 79 �� GAS FEE $ � 1�
PLUMBING FEE $
Contr. � Address
Phone .2 1—,2 .2-3 a to State License 9 so.Z'
Approved
APPLICATION FOR APPLIANC PERMIT
Date 19 FEES
Contr. Address 5
Phone State License
r
Approved
Applicants agree not to violate any of the
Workman's Compensation Laws of the
State of California
PD-1
. V
A
RECORD OF INSPECTION APPROVALS
BUILDING
DATE INSPECTOR MISC.
PAD FINAL
FOUNDATION
UNDERFLOOR
FRAME
LATH S PLASTER
GRADING FINAL
FINAL BLDG.
ELECTRICAL
DATE INSPECTOR MISC.
UNDERGROUND ROUGH
ROUGH WIRING
FINISHED WIRING
FIXTURES
MOTORS
FINAL
PLUMBING, GAS 8 APPLIANCE
DATE INSPECTOR MISC.
BACK FLOW REQ.
SANITARY NO.
UNDERGROUND ROUGH
PARTIAL ROUGH
ROUGH COMPLETE
MAIN DRAIN
FINAL PLBG.
FINAL GAS
FINAL APPLIANCE
DATE INSPECTOR MISC.
MISC
MISC
MISC
1
0�I. LOT NO.
� EET
WATER DEPT.
04 Vqq�� CITY OF CUPERTINO
NOV 4 APPLICATION FOR APPLIANCE PERMIT "
x Oi
0 <Date fA D�_ 19� Permit No. d�
U
W W Fee-$,�� .
° Application is hereby mat-de to the City of Cupertino for a permit to
o F install gas appliances as listed on the reverse side hereof, and agrees to
4z LO initall said appliances in accordance with the provisions of the Plumbing
` x Code of the City of Cupertino, and all other laws applicable thereto.
3 Use of Premises Se. Lr
o c (/ /�,( - 1--
� ;" ()wnera 4 L / •A/P�Anr!' SR. Address ../C `/ U�A/{P11%! 4,
04
zBy "! ON i7C l�/S/y , A( Address
2 CONTRACTOR,AGENT
3 <
PhoneS 233
— _
mz
W'W
ao State License 3 9'5'1—_ Approved
-
0 11 PLUMBING INSPECTOR
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GAS SERVICE NOTICE OFFICE
BUILDING INSPECTOR'S. OFFICE . COPY
CITY OF.CUPERTINO a,
' ..........if/. // /..
I To 1
You are herebyauthorized to the,G
, ✓�} AS service for. .
Owner or Tenant ......: ... . . . .
Ai
Y1 ... ..................
I' New Service v .
No. ofAMetersR
..:.... nned
-/........... y eco .. :.
Mav e-Service ......... .............
No. of Add. Meters ...........:..
. . - Move Metet .....:.:............... .,
- .............. ....... .................................
PLUMBING INSPECTOR