NO PERMIT NUMBER (5) 16, i ] / I /Z/ �7 Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINQV7 C----
Fila No. ZJ 0
t
Sanitary No.
Data 196
Application is hereby made for a permit to
a story, Type
to be occupied only as
�i
in accordance with Plot Plan, plans and Specification filed herewith„
Estimated Value of Improvements $
FEE$ Plan Check $
Ow nar I Address
Contr. Address
Phone State License
Approved
DsOpa�W
NFELECTRICAL PERMIT
Date 796 FEES '
Contr. _i6f/PEaR ��-�r-Address / r
Phone - ,2 S-l/ /UC O State Licansa / il� j' -
Approved / ') /
. APPLICATION FOR PLUMBING & GAS PERMIT /
Date 196 GAS FEE $
PLUMBING FEE $
Cont,. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEE$
Contr. Address
Phone State License
Approved
Applicants agree not to violate any of the
Workman's Compensation Laws ofthe
State of Ca liforn in
RECORD OF INSPECTION APPROVALS
FOUNDATION BUILDING
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Date Inspector
LATH 8 PLASTER
Date Inspector
FINAL
Date Insoector
ELECTRICAL
,OUTLETS \ SERVICE SIZE
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
Date Inspector
FIXTURES FINISH WIRING
Date nspector
H.P. CHARGE FIXTURES
Date nspector
PERMIT FEE Motors
10� C}Or
TOTAL FEES FINAL
Date, Inspector
PLUMBING & GAS
MAIN DRAIN SIZE I MATERIAL
STORM DRAIN SIZE TERIAL
WATER SYSTEM SIZE tATERIAL
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 WISC
' Dote 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