NO PERMIT NUMBER (2) / 4Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No. /04'-'), ����
Sanitary No.
Date / �'� 196 `S�
Application is hereb de for ape i to
a story, Type
to be occupied only as
in accordance with plot plan, Plans and Specification filed herewith.
Estimated Valve of Improvements $
FEE$ y��, _ Plan Check $
Ovi^er � .c,"`"'- �— Address
Contr. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 � // FEES
Contr. FyC -64 ,Address �U � L 'I-
Phone oG. s �2 '" FDO State License - 77/e (�
/
Approved v`�//�-� '
APPLICATION FOR PLUMBING & GAS PERMIT
Date 196 GAS FEE $
PLUMBING FEE $
Contr. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Dote 196 FEES
Contr. Address
Phone State License
Approved
Applicants agree not to violate any of the
Wor&man'.c Compensation Laws of the
State of California '
RECORD OF INSPECTION APPROVALS
FOUNDATION BUILDING
Dore Inspector
UNDERFLOOR
Date Inspector
FRAME
Date Inspector
LATH & PLASTER
Do to Ins pe c for
FINAL
Dare Ins Dector
ELECTRICAL
,OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
RECEPTACLES ad ROUGH WIRING Date Inspector
Data Inspector
FIXTURES FINISH WIRING
De Inspector
H.P. CHARGE FIXTURES kt
o, at Inspector
PERMIT FEE � Motors
P. or
TOTAL FEES aZ FINAL n ad
Date Inspect
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE LIM.6TERIAL
WATER SYSTEM SIZE 4TERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Do to 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 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