51039 (2) /Q T I /r�MMti/ Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO ! 9
File
Sanitary No.
Date 196 (1 •,
/ A pplication is ereby made far
a p(t�Iermit to
IfJ //l/ M`ri�/ story. Type
to be occupied only as
in accordance with Plot plan, Plans and Specification filed herewith.
Estimated Value of Improvements $
FEE$ Pion Check $
Owner Address
Contr. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
Contr. Address
phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date y 196 (6 GAS FEE $ A s
PLUMBING FEE $
Contr, Address
Phone State Licanse
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEE$
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
BUILDING
FOUNDATION
Data Inspector
UNDERFLOOR
Date Inspector
FRAME
Do to Inspector
LATH & PLASTER
Do to Ins pe ctor
FINAL
Do to Ins Dector
ELECTRICAL
OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
Data Inspector
FIXTURES FINISH WIRING
Date Inspector
H.P. CHARGEFIXTURES
Date Inspector
PERMIT FEE Motors
Dote Inspector
TOTAL FEES FINAL
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE I I MATERIAL
STORM DRAIN I SIZE I LoTERIAL
WATER SYSTEM SIZE ITERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Dote Inspector
STORM DRA114 FEE MAIN DRAIN `
Date Inspector
WATER SYSTEM FEE �� GAS PIPING
Dotes r
GAS PIPING FEE FINAL
I Data ns pector
PERMIT FEE 4203MISC
Date ns pe ctor
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
n,.... Ins nec/or