NO PERMIT NUMBER (3) "at No.
No. Street or
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
Fife No. a-F
Sanitary No.
Date �� jf 196 G
Application . he by made for a permit to
a story Type
to be occupied only as • •.
in accordance with Plot Plan, P ns and Specification ried herewith„
J� M�
Estimated Value of Improvements j
FEE$ �'�
Plan Check $
Owner ' �w'�^ A• ass /O 3 .0 JV
Contr. •� w�� ///��)��_ /.� S/ , Adds
Phone lams - State License//''W_1/lT p ar
Approved A/nf� /�/
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
Contr, Address
Phone State License
Approved
t.
APPLICATION FOR PLUMBING & GAS PERMIT
Date 196 GAS FEE $
PLUMBING FEE $
1
Contr. Addressf
Phone State License
1. Approved
APPLICATION FOR APPLIANCE PERMIT
Dote 196 FEES
Contr. Address
Phone Stdte License
Approved
Applicants agree not to violate any of the
Workman's Compensation Laws of the
State of California
1
RECORD OF INSPECTION APPROVALS
FOUNDATION BUILDING
Do to )
'Inspector
UNDERFLOOR
Date I ns pe ctor
FRAME
Do to Inspector
LATH 8 PLASTER
Date ector
FINAL
Date I Insoector
ELECTRICAL
.OUTLETS SERVICE SIZE
SWITCHES UNDERGROUND
Do to Inspector
RECEPTACLES ROUGH WIRING
Date Inspector
FIXTURES FINISH WIRING
H.P, CHARGE FIXTURES Data Inspector
Data Inspector
PERMIT FEE Motors
Data Inspector
TOTAL FEES FINAL
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE I I MATERIAL
STORM DRAIN I SIZE I L.JLATERIAL
WATER SYSTEM SIZE IATERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Date 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
r,
GAS DRYER PERMIT FEE
FLOOR FURNACE TOTAL FEE
INSPECTED
Data Ins pe c for