FILE 51,139 h
09; L/Ma.
No. Sir t
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
@y� D
4' File No.:f.
Y' I AUG 4 1864
Sanitary No.
Date 196
CITY OF �U'ERTINO
pp ereby made for a permit to
a story, Type
to he occupied only as
in accordance with plot plan, Plans and Specification filed herewith,
Estimated Valve of Improvements $ LSD/ 00
FEE$ D� ' Plan Check $ �
Owner CL-V'-A- A--"— Address 90617 9,o 6,4 D r
Con". Address
Phone State License
Approved
{
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
Contr. Address
Phone State License
-. Approved
APPLICATION FOR PLUMBING A GAS PERMIT
Date 196 GAS FEE $
PLUMBING FEE $
Contr. Address
Phone, State License
i
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 of the
State of California '
RECORD OF INSPECTION APPROVALS
FOUNDATION — — BUILDING '
Date Inspector
UNDERFLOOR
FRAME Date Inspector
Date Inspector
. LATH 8 PLASTE
a OILL Spector
FINAL
Date Inspector
ELECTRICAL
OUTLETS
SERVICE SIZE
,SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
FIXTURES FINISH WIRING Dote Inspector
H.P. CHARGE FIXTURES Date Inspector
Date Inspector
PERMIT FEE Motors '
Date Inspector
TOTAL FEES FINAL '
r Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN I SIZE I L,6TERIAL
WATER SYSTEM SIZE ITERIAL
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
- 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 c TOTAL FEE
;NSPECTED
Date Inspector
206q7 I Sco elc� -DR ,
LOT NO.
NO. STREET
„ Q AN FOR APPLIANCE PERMIT
W ® OF CUPERTINO
4APR 21
3 U Date
�/1 /��= X19/ ,19. LSA Permit No. '$ //j 9
.0
lr�l 1;FIicE.t� �s� Fee $ 7- ?'�
` o KPP �de to the City-of Cupertino for a permit to
o' a install gas appliance4+�ted on the reverse side hereof, and agrees to
<a install said appliances in accordance with the provisions of the Plumbing
FCode of the City of Cupertino, and all other laws applicable thereto.
S , Use y of Premises S9�le c� t-L t LLIAj y
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F CONTRACTOR, AG T eL!�j f�l a_l 3y0
- 0 Phone_ - 7 3 aG / T
uz
ao State License 1 �� yw__ Approved 2�o — —1✓
-0 PLUMBING INSPECTOR
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