51216, C-65 Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
Sanitary No. /
File No.&
Da to / 196
Application is hereby made for a permit to
a story, Type
to be occupied only as
in accordancePith Plot Plan, Plans and Specification filed,herewith,
Estimated Value of Improvements $
FEE$ . Plan Check $
Owner // . .Address
Contr. J C..AT�ty Address
Phone X7J ' /FV/ State Licens e)O L
Approved /f
J
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
Conir. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date 196 ,GAS FEE $
PLUMBING FEE $
Contr. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 1% 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
BUILDING
DATE INSPECTOR MISC.
PAD FINAL
FOUNDATION
UNDERFLOOR
FRAME
LATH & PLASTER
GRADING FINAL
FINAL BLDG. I~
ELECTRICAL
DATE INSPECTOR MISC.
UNDERGROUND ROUGH
ROUGH WIRING �
FINISHED WIRING
FIXTURES
MOTORS
FINAL
PLUMBING, GAS & APPLIANCE
DATE INSPECTOR MISC.
BACK FLOW REQ. i
SANITARY NO.
UNDERGROUND ROUGH
PARTIAL ROUGH
ROUGH COMPLETE -/
i
MAIN DRAIN
FINAL PLBG. _ /l
FINAL GAS /
FINAL APPLIANCE
DATE INSPECTOR MISC.
MISC
MISC
MISC
C—f\rzpoo--r. — 6-5
CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
Date .....5.....I-------7.0......... 19............ Building Permit No.
..................
The Building Located at ...../Q�.(3......M.0......
Owned by ------A)nR..-u.4.Fg1✓--------CpN,r
T...--.GO:
.. .
Has Been (Completed) For Use As: .....A..........C.A-9:RO-9-7. ..
(W ......... .................
0=
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l/ BUILDING INSPECTOR