51029 Lot No.
No. Street OF
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No., o a
�i Sanitary No.
Data ��— / rl 196
/(✓/f Application
is hereby made for a permit to r
t•' ��"� a story, Type a
to be occupied only as
in accordance 4h Plot Plan, Plans and Specification filed herewith„
Estimated Value of Improvements S lo Q
FEES A Plan Check $
Owner A&& Address G'
Contr. Address
Phone / � T State License
Approved
7 0 oS7
t
APPLICATION FOR ELECTRICAL PERMIT
Date
1196-sFEES
Contr. YI / iR1. Address
Phone 73(, — /.Iza
State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date 196 GAS FEE $
PLUMBING FEE E
Contr. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEES
Contr. Address
Phone State License
Approved
Applicants agree not to violate any of the It
Workman's Compensation Laws of the
State of California
RECORD OF INSPECTION APPROVALS
FOUNDATION BUILDING - -
Date Inspector
UNDERFLOOR
Date .. Inspector
FRAME
Date Inspector
LATH & PLASTER
Do to Ins pe ctor
FINAL
Date Ins oe c for '
ELECTRICAL
OUTLETS Q
SERVICE SIZE
SWITCHES 2. 40 UNDERGROUND
3 Date Inspector
RECEPTACLES ROUGH WIRING
I -' Data Inspector
FIXTURES FINISH WIRING 17
Date Inspector
H.P. CHARGE FIXTURES-
�y Dae Inspector
PERMIT FEE � Motors
I � t ns .actor
TOTAL' FEES FINAL
D toInspector
PLUMBING & GAS
MAIN DRAIN SIZE I I MATERIAL
STORM DRAIN I SIZE I LoTERIAL
WATER SYSTEM SIZE TERIAL
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
Dote 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.