NO PERMIT NUMBER /0 O I ✓ K/ �� Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No. s � OA'q
Dote 196
Sanitary No.
��
Application is hereby made for a pe it to
✓� Type
to be occupied a y
i cnrdance with Plot Plan, Plans and Specification filed herewith,
Estimated Value of Improvements $
FEE$ Plan 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 J / 196 GAS FEE $
�� , a PLUMBING FEE $
Contr. /�'p�p' s /�/ Address
Phone State License S�
Approved
APPLICATION FOR APPLIANCE PERMIT
Data 196 FEE$
Contr. Address
Phone State License
Approved
Applicants agree not to violate any of the.
91orkmanrs Compensation Laws of the -
State of California
RECORD OF INSPECTION APPROVALS
BUILDING
FOUNDATION
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Date Inspector
LATH & PLASTER
Date Inspector
FINAL
Do to Ins Do c tar
ELECTRICAL
,OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
Date Inspector
FIXTURES FINISH WIRING
Date Inspector
H.P. CHARGE FIXTURES
Date Inspector
PERMIT FEE Motors
Date Inspector
TOTAL FEES FINAL
Dote Inspector
PLUMBING & GAS
MAIN DRAIN SIZE I MATERIAL
STORM DRAIN SIZE 1161ATERIAL
WATER SYSTEM SIZE tTERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Date Ina pe ctor
STORM DRAIN FEE MAIN DRAIN
Date Inspector
WATER SYSTEM FEE � � GAS PIPING
Date for
GAS PIPING FEE FINALS'
Date ns pactor
PERMIT FEE 0, MISC
Date na pec for
TOTAL FEE MISC
Data 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
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