NO PERMIT NUMBER Lot No.
No. f� Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
Sanitary No.
O
File No.,/C)
Do to 196
Application is hereby made fora permit to
a story, Type
to be occupied only as
in accordance with Plot Plan, Plans and Specification filed herewith,
(Estimated Value of Improvements $
FEE$ / Plan Check f
Owner _Gr DO i '
�` � � Address s
Contr. CX.s...iC.ti� Address fyV C—
Phone Zj /.. 2 FState License /� �✓
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEEf
Cont, Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Dote 196 GAS FEE f
PLUMBING FEE f
Cont, Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEES
Cont,. Address
Phone State License
Approved r
Applicants agree not to violate any of the
Workman's Compensation Laws of the
State of Califnrnia
RECORD OF INSPECTION APPROVALS°
BUILDING
DATE INSPECTOR MISC.
PAD FINAL
FOUNDATION
UNDERFLOOR
FRAME
LATH & PLASTER
GRADING FINAL
FINAL BLDG.
ELECTRICAL
DATE INSPECTOR MISC.
UNDERGROUND ROUGH
ROUGH WIRING
FINISHED WIRING
FIXTURES
MOTORS
FINAL
PLUMBING, GAS & APPLIANCE
DATE INSPECTOR MISC.
BACK FLOW REO.
SANITARY NO.
UNDERGROUND ROUGH
PARTIAL ROUGH
ROUGH COMPLETE
MAIN DRAIN
FINAL PLBG.
FINAL GAS
FINAL APPLIANCE
DATE INSPECTOR MISC.
MISC
MISC
I
MISC
/O LCI7jl -tT A-QC1
.No- Lot Lot No.
A,P,L CA IION FOR APPLIANCE PERMIT -
(( City of Cupertino
S ' 19 Permit No. /00
Fee
3 -nP-1Appli1ar)6n SAPeb R JIOQhe City of Cupertino fora 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
3. w thereto.
°J- $ Use of Premis �oyc
A
Owner
o E'e Address ,.
3 0 BY _ - ress
onlraclor,,Agent
E
Phone
.. 0 '
I State License (� : 1rA-Ap 4 ed
Plumbing Inspector" "'
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