NO PERMIT NUMBER No.��U` //JJ�� lnj � ////�� Lot No.
�et v`�""ici /�r/v r
441
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No. ,f d
Sanitary No.
Data 196
Application is heyl/smadc for permit to
a ory, Type
' to he occupied Ly as
n accordant Plan, Plans and Specification filed herewith,
,Estimated Value of Improve is $
FEES ^ ' _ `J Plan Check E
Owner s—/�/1 ✓ Address
Contr, Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEES
Contr. Address
Phone State License
rn 1�
CC Approved
A PIDEZTIU 9864PL GING & GAS PERMIT
DareI T��n GAS FEE E y
GITY PLUMBING FEEE I
Contr. KZ40L Address /fir,,
,7 14 S
Phone M100APA State Licensl(
,If1'Ll_ Approved
APPLICATION FOR APPLIANCE PERMIT
Data 196 FEES
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
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Date Inspector
LATH & PLASTER
Date Inspector
FINAL
Date Insoector
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
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE I MATERIAL
STORM DRAIN SIZE LLATERIAL
WATER SYSTEM SIZE TERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE �� PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Date Inspector
STORM DRAIN FEE MAIN DRAIN
Date Inspector
WATER SYSTEM FEE % GAS PIPING
Date Inspector
GAS PIPING FEE FINAL
Date Inspector
PERMIT FEE �' � MISC
Date nspecter
i TOTAL FEE - r 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
Do to Inspector
102+1 1n7'r1,Lr- Dr. LO' 0.
NO. STREET e z
CITY OF CUPERTINO j
APPLICATION FOR APPLIANCE PERMIT
�,h PermitNo,
Dote ii 1/`J/75 , 19— Fee$
C
Application is hereby made to the City of Cupertino for a permit to install gas
appliances as listed on the reverse side hereof, and agrees to install said appliances in
accordance with the provisions of the Plumbing Code of the City of Cupertino, and all
other laws applicable thereto.
Use of Work To Be
Premises 'ieside,Lce Performed 2'unrtCe Installed
Owner ri''.rold J. F1 irIl Ell se TAddress T (12LL1 Ph�rl .� nr '
,Phone 257-6731 T
By J L11ev HPgt; no' M CocAadrea` (33 ,o , 13th at, 3 . J.
Contractor,Agent
Phone-294—;21)?
,State License 253' 5 40 Approved
Plumbing Inspector
I' I AGREE I WILL NOT VIOLATE ANY OF THE WORKMEN'S
}lJ— COMPENSATION LAWS OF THE STATE OF CALIFORNIA.
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