NO PERMIT NUMBERLot
Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
Do to 196
Applicat" is'herA
to he occupied on
File No. 5—/04/
Sanitary
to
a story, Type
in accordance with plot Plan, Plans and Specification filed herewith,
Estimated Value of Improvements $
FEE$
Plan Check $
Owner
/
Cont,.
Address
Phone
State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 1
Contr.
Phone
Do to
FEES
Address
State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
196
GAS FEE $
PLUMBING FEE $
Contr. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT d�
Date ! 196 es FEE$
Contr: Address
Phone` X " State License
r/O r
A pproved l� /
Applicants agree not to violate any of the
Workman's Compensation Laws of the
State of California
RECORD OF INSPECTION. APPROVALS
FOUNDATION BUILDING
Dote
UNDERFLOOR
Date
FRAME
Do to
LATH 8 PLASTER
Do to
FINAL
Do to
ELECTRICAL
Inspector
Inspector
Inspector
Inspector
Ins oe ctor
SERVICE SIZE
UNDERGROUND
SIZE
FEE
,OUTLETS
Date
Inspector
SWITCHES
'
RECEPTACLES
Date
Inspector
FIXTURES
UNDERGROUND
H.P. CHARGE
Date
Inspector
PERMIT FEE
MAIN DRAIN FEE
TOTAL FEES
Date
Inspector
ELECTRICAL
Inspector
Inspector
Inspector
Inspector
Ins oe ctor
SERVICE SIZE
UNDERGROUND
SIZE
FEE
MATERIAL
Date
Inspector
ROUGH WIRING
'
REGISTERS
Date
Inspector
FINISH WIRING
UNDERGROUND
COMBUST ON VENT
Date
Inspector
FIXTURES
MAIN DRAIN FEE
MISC
Date
Inspector
Motors
MAIN DRAIN Date
Inspector
Data
Inspector
FINAL
Inspector
'
GAS PIPING FEE
Date Inspector
PLUMBING & GAS
MAIN DRAIN
SIZE
FEE
MATERIAL
UNITS
STORM DRAIN
SIZE
TERIAL
REGISTERS
WATER SYSTEM SIZE
ITERIAL
TOTAL FIXTURES.
UNDERGROUND
COMBUST ON VENT
FIXTURE FEE
PARTIAL ROUGH
MAIN DRAIN FEE
MISC
Dote
ROUGH COMPLETE
'Inspector
STORM DRAIN FEE
MAIN DRAIN Date
Inspector
WATER SYSTEM FEE
GAS PI Date
NG
Inspector
'
GAS PIPING FEE
PERMI E
FINAL Date
Inspector
_PERMIT FEE �
Date
MISC
Inspector
TOTAL FEE �
Date
-MISC
Inspector
Date Inspector
APPLIANCE
TYPE OF APPLIANCE
UNITS
FEE
TYPE OF APPLIANCE
UNITS
FEE
.CIRCULATING HEATERS
REGISTERS
BLOWER FURNACES
COMBUST ON VENT
SUSPENDED UNIT
MISC
GAS RANGE
MISC '
GAS DRYER
PERMI E
pLE►-
FLOOR FURNACE
TOT
O V
INSPECTED ( 4e .r �— K7fo
Date Inspector