NO PERMIT NUMBER (2) O O/ Z I Lot No.
7
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No. &L
Sanitary No.
Date 196;,7- -
�Ap�pliiccation is hereby made for a permit to
toy,
Rory. Type
to be occupied only as
in accordance with Ploorplan, Plans and Specification filed herewith,
Estimated Value of Improvements s DE 0 6 � O
FEE$ Plan Check $
Owner Address `
Contr. / Address
Phone Z.1- —� G Se state License y^
Approved r IL
s
APPLICATION FOR ELECTRICAL PERMIT
Data s 196
FEES
i n
GmteT, Address k-,7
Phone - S 3"' oZ��y State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Data 196 GAS FEE $
PLUMBING FEE $
Contr. 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
FOUNDATION BUILDING
Date Inspector ,.
UNDERFLOOR
FRAME Date ' 'Inspector
Data Inspector
LATH & PLASTER '
FINAL I& s actor
Date Inspector -
ELECTRICAL
,OUTLETS
SWITCHES UNDERGROUND SERVICE SIZE
RECEPTACLES ROUGH WIRING Do to Inspector
Date Inspector 77
FIXTURES FINISH WIRING
H,P. CHARGE, FIXTURES Date Inspector
Date Inspector
PERMIT FEE Motors
i p nspactor
TOTAL FEES FINAL V
Date Inspector -
PLUMBING & GAS
MAIN DRAIN SIZEMATERIAL
STORM DRAIN SIZE MATERIAL
WATER SYSTEM SIZE I- T ERIAL
TOTAL FIXTURES . UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Do t6 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
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
I AGREE I WILL NOT VIOLATE ANY OF THE WORKMEN S
COMPENSATION LAWS OF THE STATE OF CALIFORNIA.
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