NO PERMIT NUMBER ik
1 ./ _ -
24 Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF C.. I.. " q/U TINO �Al.
C�'�y/J�
F{I �a
Sanitary No.—/Z/ -
Dote 1 6
Applica ' n i?her e for, permit to
a story, Type
to'he occupied only s '
in accordance with Plot Plan, Plans and Specification filed herewith.
Estim tad Value of Improvements $
FEE$ Pion Check $
Own ^er 11 N z � t —_Address
Cont,. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date - � 196 GAS FEE $
PLUMBING FEE $
Contr, `�/'���/=a Address 3 7
p
Phone —�'/(/� ell _ State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 1% FEES
Contr. Address
Phone State License
Approved
Applicants agree not to violate any of the-
Workman's Compensation Laws of the
State of California
PAD FINAL ,.
GRADING FINAL
RECORD OF INSPECTION APPROVALS
BUILDING
FOUNDATION
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Date Inspector
LATH & PLASTER
Date Inspector
FINAL
Date Ina sector
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 TERIAL
WATER SYSTEM SIZE ITERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUG
Datenspector
MAIN DRAIN FEE ROUGH COMPLETE
STORM DRAIN FEE MAIN DRAIN
13" tar
Date Inspector
WATER SYSTEM FEE GAS PIPING
Data Inspector
GAS PIPING FEE FINAL '
Date Inspector
PERMIT FEE MISC
ate nspector
TOTAL FEE MISC
/ to 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
-7 -Bldg. Dept
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
Sewer Connection SanitaV P mit No. ......
tz( ..............
!rmit No.
(1�.O�, Iumbing Final NtiR Nn'c 4*e-lej
.41
LotNo. ........1.......................
Owner or Tenant
.....................................
AtA ...................................................
Tract .......... .................... ........... ....................
...........................................................
Date Connected ---------------------- .......................................
DateFinal ............................... ............. .... .......................... 19.
............. ......................
PLUMBING:,'INSPECTOR
III 7/63-IM
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