NO PERMIT NUMBER No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File N..100- 06.r
Sanitary No.
Date 196
Application is hereby made for a permit to
a story, Type
to be occupied only as
in accordance with Plot Plan, Plans and Specification filed herewith.
Estimated Vale, of Improvements $
FEE$ Plan Check $
Owner Address
OF
Contr. - Address
Phone caftzy�
State License
Approved
c
APPLICATION FOR ELECTRICAL PERMIT
Date 196 r FEE$ Z 0—
Contr. V Address .—/0 0,0/�(Lt�Y�`
Phone ot" ' .Ssa State License /''l 7 _
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Data 196 GAS FEE $
PLUMBING FEE $
Contr. Address
Phone State
License
Approved
APPLICATION FOR APPLIANCE PERMIT
Data 196 FEES
Contr. Address
Phone State License
Approved
Applicants agree not to violate any of the
Workman's Compensation Laws ofthe
State of California
RECORD OF INSPECTION APPROVALS
FOUNDATION BUILDING
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Date Inspector
LATH & PLASTER
Date Inspector
FINAL
Date Inspector
ELECTRICAL
,OUTLETS
SERVICE 517_E
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
Date Inspector
FIXTURES. FINISH WIRING
UV Date Inspector
.P. CHARGE , FIXTURES
Date Inspector
PERMIT-FEE P'Y Motors
jj D f s ctor
TOTAL FEES a2 FINAL
ate Inspector
PLUMBING & GAS
MAIN DRAIN SIZE I I MATERIAL
STORM DRAIN I SIZE I Lmm6TERIAL
WATER SYSTEM SIZE IATERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Data 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
' Data 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