NO PERMIT NUMBER / S
No. Street
APPLICATIONOR BUILDING PERMIT
CITY OF CUPERTINO
File N/-19 6
Sanitary No.
Date 196
Application is hereby made for a permit to
a story, Type
to be occupied only as lit
ace once with Plot Plan, Plans and Specification filed herewith.
Estimated ae Improvements $
FE E$ Plan Check $
Owner Addres
Contr. Address
a
Phone Stat se
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
Contr, Address
Phone ^ State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Data / 196 GAS FEE $ —
in(I ' Q' PLUMBING FEE xyA
Contr. . IeS" 0 �+ Address 'r0 e /y/'
AV
Phone ��J . a/p3 State License -����7//��/7ppAZ[ -
Approved AZOA6/./
APPLICATION FOR APPLIANCE PERMIT
Data 196 FEES
Contr. Address
Phone State License
Approved
Applicants agree not to violate any of the
Workman's Compensation Latus of the
State of California
RECORD OF INSPECTION APPROVALS
FOUNDATION BUILDING
UNDERFLOOR Do to Inspector
FRAME Date Ins pe ctor
Date Inspector
LATH 8 PLASTER
FINAL Data Inspector
Date Ins De c tar
ELECTRICAL
.OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
RECEPTACLES ROUGH WIRING Date Inspector
FIXTURES FINISH WIRING Date Inspector
H.P. CHARGE FIXTURES Date Inspector
PERMIT FEE Motors Date Inspector
TOTAL FEES FINAL Date Inspector
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE I I MATERIAL
STORM DRAIN I SIZE I LowITERIAL
WATER SYSTEM SIZE TE AL, -w(�
TOTAL FIXTURES UNDE GROUN
FIXTURE FEE PARTI L ROUGH
Data Inspector
MAIN DRAIN FEE ROUGH MPLETE '
Date Inspector
STORM DRAIN FEE MAIN DRAIN
Date 'Inspector
WATER SYSTEM FEE GAS PIPING
GAS PIPING FEE FINAL Date Inspector
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