FILE 5113512 -3
-
No.
Date
to he
Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
—196
Application is hereby made for a permit to
a
Lot
File No.
Sanitary No.
Type
( //I Nov in in ac gr&nr�py'#(t Plot Plan, Plans and Specification filed herewith.,
,I#L Estimated Value LYof Improvements $
e
FEES rr OF IJJPERTO �' Plan Check $
Owner //L.� Address ULE rIr.r
Contr, Address /
Phone w
State Lice ns
Approve � �
Date
Contr.
Phone
APPLICATION FOR ELECTRICAL PERMIT
196
FEES
Addrese
State License
.. Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Phone
Applicants agree not to violate any of the
Workman's Compensation Laws of the
State of California
State License
Approved
.r
Date
196 GAS FEE $
PLUMBING FEE $
tC•
Contr,
Address
Phone
State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Data
196 FEES
Contr.
Address
Phone
Applicants agree not to violate any of the
Workman's Compensation Laws of the
State of California
State License
Approved
.r
RECORD OF INSPECTION APPROVALS
SIZE
BUILDING
FOUNDATION
UNITS
FEE
Date
STORM DRAIN
UNDERFLOOR
RECEPTACLES
Date
FRAME
H.P. CHARGE
tTERIAL
RIAL
Da e
LATH & PLASTER
TOTAL FEES
UNDERGROUND
' t
FINAL
MISC
ELECTRICAL
UNDERGROUND
ROUGH WIRING
FINISH WIRING
FIXTURES
Motors
FINAL
PLUMBING & GAS
Inspector
Inspector
Inspector
Inspector
Inspector
SERVICE SIZE
,Date Inspector
Date
Date
Dote
Date
Dote
Inspector
Inspector
Inspector
Inspector
Inspector
MAIN DRAIN
SIZE
FEE
,OUTLETS
UNITS
FEE
SWITCHES
STORM DRAIN
SIZE
RECEPTACLES
FIXTURES
WATER SYSTEM
H.P. CHARGE
tTERIAL
RIAL
PERMIT FEE
TOTAL FIXTURES
TOTAL FEES
UNDERGROUND
ELECTRICAL
UNDERGROUND
ROUGH WIRING
FINISH WIRING
FIXTURES
Motors
FINAL
PLUMBING & GAS
Inspector
Inspector
Inspector
Inspector
Inspector
SERVICE SIZE
,Date Inspector
Date
Date
Dote
Date
Dote
Inspector
Inspector
Inspector
Inspector
Inspector
MAIN DRAIN
SIZE
FEE
I MATERIAL
UNITS
FEE
CIRCULATING HEATERS
STORM DRAIN
SIZE
REGISTERS
BLOWER FURNACES
WATER SYSTEM
SIZE
tTERIAL
RIAL
SUSPENDED UNIT
TOTAL FIXTURES
MISC
UNDERGROUND
GAS RANGE
FIXTURE FEE
MISC
PARTIAL ROUGH
GAS DRYER
MAIN DRAIN FEE
PERMIT FEE
ROUGH COMPLETE
Date
Inspector
STORM DRAIN FEE
MAIN DRAIN
Date
Inspector -
WATER SYSTEM FEE
GAS PI NG
Date
Ina pe ct or
GAS PIPING FEE
FINAL
Dote
Inspector
PERMIT FEE
MISC
Date
Inspector
TOTAL FEE
MISC
Date
Inspector
ware tns pe cror
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
t
INSPECTED
Dn to Ins me/er
RECORD OF INSPECTION APPROVALS
FOUNDATION
UNDERFLOOR
DATE: IINSPECTOR
DA'I'S INSPECTOR
FRAME
DATE INSPECTOR
LATH and PLASTER
A"I'E INSPECTOR
FINAL BLDG. I 1 I o
DA 6SPF.CrOR
FINAL ELEC.
DATE
INSPECTOR
FINAL PLBG,
DATE
INSPECTOR
FINAL GAS
Adilk
DATE
INSPECTOR
P3
il3,
/0
3 i, AV /WVi Kew Y1DT
f
NO ly
NO. STREET
APPLICATIFOtt BUILDING PERMIT
CITY OF CUPERTINO
Sanitary No.
Date 1/ 0' 196,4/ Permit No.
Application is hereby made for a permit to
a story, Type If Y / 2 Building
to be occupied only as'
in accordance with Plans, SiOcifications and Plot -Plan filed herewith.
Estimated Value of Improvements, $ Z tl .^` Fee $
It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
all other laws applicable to the construction, locatiop, and use of bu' dings within the City of
Cupertino w 11);, compl' d with. `
Owner • �.a..�e. Address eta
By Address
Phon
Approve
State License BUILDING
/ Ogsc- I mo(/iyN A�..� LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
ro s� CITY OF CUPF.RTINOSanitary
rc LL
0 U?tp
19oz Permit No
3� V 14 /
w LL Pee $ •3.�0
�o
� Application is hereby made to the City of Cupertino for a permit to install plumbing
o r p sT,�{d/ xtM}�I'� reverse side hereof, and agrees to install said prices
> a atidl/brlfixr�s iit"�ttoc4il the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
w x
� r
Use of Premises
00
> /03.3 (
0 3 Owner Address
0 J B Addressl�1111' 0 _
J� Y
3 � CONTRACTOR, AGENT
w z
a -�.� S<<%5';� ApprovedWILLIAM D. BENEVICH
o o x State License-
U PLUMBING INSPECTOR /
FIXTURES I NUMBER II MAIN DRAIN I
UNITSI FEES UNITS I FEES
Waste
To Prov. Line
Not Conn.
Sewer Box
Size
Comb.Sink & Tray To Curb
Dental Unit
Floor Drain I 1 11 WATER SYSTEM
Fee
Water Leader I 1 11 Storm Drain Fee
Breaker
Total I % I II Total Fee