NO PERMIT NUMBER .21-7611 d� z Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO r
File No.
/ Sanitary No.'
Dote 196
Ap{tlication o�ade� permit to.
st Type
to he occupied only as
in accordance with Plot Plan, Plans and Specification filed herewith„
Estimated Value of Improvements $
FEES Plan Check $
Owrmr ���llll///7/777TTTT C �ddress
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 / 196 GAS FEE $
PLUMBING FEE $
Contr. -7AAddress ' t)
Phone `3 / 9' -�--o State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 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- I
FOUNDATION BUILDING
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Data Inspector
LATH & PLASTER
Date Inspector
FINAL..
Date Ins oe c for
E'L'ECTRICAL
,OUTLETS SERVICE SIZE
SWITCHES. UNDERGROUND
Data Inspector '
RECEPTACLES ROUGH WIRING
Date Inspector
FIXTURES FINISH WIRING
H.P, CHARGE FIXTURES Date Inspector
Date Inspector
PERMIT TEE Motors
Date Inspector
TOTAL FEES FINAL
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE MATERIAL
WATER SYSTEM SIZE ITERIAL
v
TOTAL FIXTURES �a`� UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
� MAIN DRAIN FEE ROUGH COMPLETE
Dote Inspector
STORM DRAIN FEE MAIN DRAIN
Date Inspector
WATER SYSTEM FEE GAS PIPING
�9ata I r
GAS PIPING FEE � � FINAL
Date Inspector
� PERMIT FEE a- MISC
s-U Date Inspector
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
Date Inspector