51003No.
street (/
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
Date 196
.. Application is hereby made for a permit to
to be occbed only as
Lot No.
File No. s/0O3
Sanitary No.
story, Type
in accordance with Plot Plan, Plans and Specification filed herewith,
Estimated Value of Improvements $LSQUCAI.
FEE$ Ila n� Check $
Owner '•- It e � � 1%' vd8/A. '
Contr, p p Address �j
Phone « s �' %O / �' State LicenseeI /��rL
.. ... .. APProved W • • .'�f/
APPLICATION. FOR ELECTRICAL PERMIT
Date 196 FEE$
Conte Address
Phono State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date 196 GAS FEE $
PLUMBING FEE-_$ _
Conte Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 1% FEES
Contr, Address
Phone Stu to, L,ieense
Approved
Applicants agree not to violate any of the
Workmen's Compensation haws of the ,
State of California
i
n
RECORD OF .ANLS
FOUNDATION �✓"
Zec or
UNDERFLOOR
Date • laspector'
FRAME
Data Inspector
LATH & PLASTER t
Dwve - Inspector
FINAL
Date Ins oector
ELECTRICAL I'
UNDERGROUND
ROUGH WIRING,
FINISH WIRING_
FIXTURES__
'Motors
FINAL
SERVICE SIZE
Date Inspector
Date
Date
Date
Data
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE MATERIAL
Inspector
Inspector
Inspector
pector
Inspector
WATER SYSTEM
SIZE
FEE -
,OUTLETS
TOTAL FIXTURES.
SWITCHES
UNDERGROUND
RECEPTACLES
PARTIAL ROUGH
FIXTURES
-
H.P. CHARGE
Inspector
MAIN DRAIN FEE
PERMIT FEE
ROUGH COMPLETE
TOTAL FEES
Date-
UNDERGROUND
ROUGH WIRING,
FINISH WIRING_
FIXTURES__
'Motors
FINAL
SERVICE SIZE
Date Inspector
Date
Date
Date
Data
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE MATERIAL
Inspector
Inspector
Inspector
pector
Inspector
WATER SYSTEM
SIZE
FEE -
ATERIAL
TOTAL FIXTURES.
BLOWER FURNACES ' COMBUSTION VENT
UNDERGROUND
FIXTURE FEE
PARTIAL ROUGH
GAS RANGE) �t MISC` '-
-
Date"
Inspector
MAIN DRAIN FEE
ROUGH COMPLETE
Date-
pacror
STORM DRAIN FEE
MAIN DRAIN
Date
'I spetlor
WATER SYSTEM FEE
GAS PI NG
a
actor
GAS PIPING FEE -
.FINAL i
Pate
"Inspector
PERMIT FEE
MISC
Date
Inspector
'TOTAL FEE
MISC
APPLIANCE
TYPE OF APPLIANCE UNITS FEE TYPE OF APPLIANCE
UNITS
FEE -
CIRCULATING HEATERS. REGISTERS
BLOWER FURNACES ' COMBUSTION VENT
SUSPENDED UNIT MISC - -
GAS RANGE) �t MISC` '-
GAS DRYER PERMIT FEE
cL n00 PIIRNACF_ - i- TOTAL FEE
INSPECTED
Date — I Inspector
n
I AGREE I WILL NOT VIOLATE ANY OF THE V"ORRI.IEN S
COMPENSATION LAWS
OF THE
STATE OF CALIFORNIA.
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