FILE 51,259.2/r6
No.
Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
Date � �'S 196 7
Application is hereby made for a permit to
to be occupied only asJ���� r -G
in accordance with plot
Lot No.
Sanitary No. p
File. No.�'2's �•.Z.i
story, Type
Plans and Specification 41ed herewith,
Estimated Value of Improvements $
FEE$ 7 an Check $
Owner Address
Contr.Address
Phone State License /� o
Approved
APPLICATION FOR ELECTRICAL PERMIT
Data
196 FEE$
Conte
Address
Phone
State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Dote
196 GAS FEE $
PLUMBING FEE $
Contr.
Address.
Phone
"' State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Dote
196 FEES
Contr.
Address
Phone
State License
Approved
Applicants agree not to violate any of tho
Workman's Compensation Laws of the tt,'"
State of California
RECORD OF INSPECTION APPROVALS
BUILDING
DATE INSPECTOR MISC.
IAD FINAL 11
FOUNDATION
UNDERFLOOR
FRAME
LATH & PLASTER
GRADING FINAL
FINAL BLDG.
UNDEF
ROUGI
FINISH
FIXTU
MOT OI
FINAL
ELECTRICAL
DATE INSPECTOR MISC.
GROUND ROUGH
WIRING
ED WIRING
RES
IS
PLUMBING, GAS & APPLIANCE
DATE INSPECTOR MISC.
BACK FLOW REQ.
SANITARY NO.
UNDERGROUND ROUGH
PARTIAL ROUGH
ROUGH COMPLETE
MAIN DRAIN
FINAL PLBG. J
FINAL GAS /� ��� a2
FINAL APPLIANCE % �'"
DATE INSPECTOR MI
CITY OF CUPERTINO
COPY
GAS SERVICE NOTICE
To
You are hereby authorized to connect the GAS service for
Owner or Tenant ..... .. ............ .... ...�.......... - _.....__.......
At
New Service ................ .._.
No. of Meters .....�._....... Reconnect
Move Service .......... _.......
No. of Add. Meters ............ Move Meter
01/1
PLUMBING INSPECTOR
19(-7X- S1 VA V, 9Y `I Jd . LOT NO
NO. STREET
CITY OF CUPERTINO
My of u?APPLICATION FOR PLUMBING
Date T1.3_ A, ig
PERMIT
Sanitary No.
Permit No.
Fee $
Applicatibn rSthereby made to the City of Cupertino for a permit to install plumbing
pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
cup. o, and all other laws applira ble there
Use Marl Work To Ba
Prem' Parformetl AS l 'r
Owne Atltlress
By
Contractor,
Phone
State License buzimgr -
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tj. LOT
NO. STREET
CITY OF CUPERTINO
clic OP CQMAICATION FOR APPLIANCE PERMIT
Dace' 19 _ Permit No.
00
Fee -s_
Application is hereby nraxle to the City of Cupertino for a permit to
install gas appliances as listed on the reverse side hereof, ay agrees to
install said ap es in accordance with the revisions of th Pluml n
Code of the ity f Cupertino, and II of er t ap lic th e
Use ofises �1 �' ^ NS t ,
By
CONTRACTOA, AGENT
State License_171NO, 1►*% V y'
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