NO PERMIT NUMBER _//Q 10 I >z . Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
Sanitary No.
Date 196
File Nl A-�a'�
O
� '
Application is hereby made for a permit to
O �—SLOT. Type
to 6e occupied only as C2==Qy
in accordance with Plot Plan, Plans ars Specification filed herewith,
Estimated Value of Improvements $
FEE$ – � Plan Check $
Owner
�+� � Address �� �/ �
Contr. Address IFP`p.T�'�./�
Phone 01L 9 77 State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Data 196 FEE$
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Dote 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 'of the
State of California
RECORD OF INSPECTION APPROVALS
BUILDING
DATE INSPECTOR MISC.
PAD FINAL
FOUNDATION
UNDERFLOOR
FRAME
LATH & PLASTER
GRADING FINAL
FINAL BLDG.
ELECTRICAL
ATE INSPECTOR MISC.
UNDERGROUND ROUG
ROUGH WIRING
FINISHED WIRING
FIXTURES
MOTORS-
FINAL-
PLUMBING,
OTORSFINALPLUMBING, GAS & APPLIANCE
DATE INSPECTOR MISC.
BACK FLOW REQ.
SANITARY NO.
UNDERGROUND ROUGH
PARTIAL ROUGH
ROUGH COMPLETE
MAIN DRAIN
FINAL PLBG.
FINAL GAS
FINAL APPLIANCE
DATE INSPECTOR MISC.
MISC
MISC
S
MISC
IN 0. �� L� LOT NO.
N Q
r o �P ION FOR ELECTRICAL PERMIT
a _ p*`—
o J t 'ITY OF CUPERTINO
3a
W W O
G / 19; !b
o F rT Permit No. O v
r Fee ti
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w rt4li�{@n 1�EKWD the City of Cupertino for a permit to install electrical
WarTB;or xtnres as listed on the reverse side hereof, a d agrees to install said
20 wiring and/or fixtures in accordaric with the provisions ofectnc. �jod�°f t`h��
> W City of Cupertino, and al cher !asys applicable thereto. wo
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Use of Premises _
J Z
J G
3 < Owners Address
a By � a�4 ' - AddressRINSPEC:rORK
U' I CONTRACTOR, AGENTApprovedELECTR
State License�"�U7�ci-C/V
v
M1Yl �CC�)
Size Service Conduit----------------------Number of Outlets-------a-2------ -.-----.-- ----------
Size Service Wires--------------------------Number of Switches................ .......... .......... -..._-.-.....
Size Service Switch........................Number of Receptacles............ .......... .......... .......
OT/
Size Sub Feed Conduit------------------Number of Fixtures...... ..... .......... .
Size Sub Feed Wires....................Ranges---------------- KW.............. .......... .......... ........---.
Numberof Circuits------------------- Oven ------------ KW.............. .......... .......... ..............
Number of Meters........................Signs.......... Transformers........ .. ....... .......... ..............
Misc------------------------ ------Dryers_---.......-.-.-....._.........--- ---- ------ -
Motors.................... HIS------------------.- Phase.................... Permit Fee
Motors-------------------- HP.................... Phase--.....----.-.....--
Motors.................... HP------------------- Phase.................... H P Charge-------------- ..--...--
TOTAL FEES w
RECORD OF INSPECTION APPROVALS
RoughWiring................I---------------------------- Fixtures ...... ...............I..................... ......
DATE INSPECTOR DATINSPECTOR
Finish Wiring ......---......I---------------------- otors - -----I.-...-------------.......
DATE INSPECTOR DATE INSPECTOR
Final -..--..._...------....I---- ---------------------
OATE INSPECTOR