NO PERMIT NUMBER �C DDS D I �' iE�Cif�Gt' Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
Sanitary No.
Q ' 6 File No.
Date _ 3 /9 .196_�
Application is hereby made fora 4
emit to
1 11 A—�4—
p
to be occuAied only as
in accordance with plot plan, plans and Specification filed herewith,
Estimated Value of Improvements $
FEES — /9� Plan Check E
Owner (�QiQ/ Address woay
C ontr. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Data 196 FEES
Contr. 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
Data 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 8 PLASTER
GRADING FINAL
FINAL BLDG.
ELECTRICAL
DATE INSPECTOR MISC.
UNDERGROUND ROUGH
ROUGH WIRING
FINISHED WIRING
FIXTURES
MOTORS-
FINAL
OTORSFINAL
PLUMBING, GAS 8 APPLIANCE
DATE INSPECTOR MISC.
BACK FLOW REQ.
SANITARY NO.
UNDERGROUND ROUGH
PARTIAL ROUGH
ROUGH COMPLETE
MAIN DRAIN
FINAL PLBG.
FINAL GAS
FINAL APPLIANCE
DATE INSPECTOR MISC.
MISC
MISC
MISC
{
Zoo
NO. STREET LOT NO.
APPLICATION FOR ELECTRICAL PERMIT
CITY OF CUPERTINO
Date - 1950 Permit No. p
Fee 5 0 `—
Application is hereby made to the City of Cupertino for a permit to install electrical
wiring and/or fixtures as listed on the reverse side hereof, and agrees to install said
wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
City of Cupertino, and all other laws ap Iicable thereto.
Use of Premiqeq `�✓' <`�
a Owner — Al
rT- e' �1 Address �'o° o / "� '
v
Ey Address
CON AACTOR,/AGENT If ApprPPPV
Phone: i6 Y � 4o � / ELECTRICAL rNSPECroa
r
NEW �,RPL FEES
Size Service Conduit.........------------Number of Outlets.................. .......... .........
Size Service Wires.........................Number of Switches---------.---.-- --
Size Service Switch------------------------Number of Receptacles............ . .--....... ..............
Size Sub Feed Conduit..................Number of Fixtures....-.....-------- .......... .......... ..............
Size Sub Feed Wires....................Ranges---------------- KW.............. --------- --:....... ..............
Number of Circuits-----'--........-- Oven „-----.---.- KW.............. .......... .
Number of Meters........................Signs---------- Transformers........
I........-- ---------- ----.---------
Misc---------'......................................Dryers_--'----------------------------- ----------I.......... ..............
Motors-------------------- HP-------------------- Phase.................... Permit Fee $SL00
Motors.................... HP.................... Phase-------------------.
Motors-------------------- HP------------------ Phase------------------ H P Charge..............-- ------------
TOTAL FEES
RECORD OF INSPECTION APPROVALS
RoughWiring................ -------------------------- Fixtures ---------------------- ---------------------------
DATE INSPECTOR DATEINSPECTOR
Finish Wiring .-..-'--.. ......................... Motors ............._.........
�--........._.--..-..---'-'
DATE INSPECTOR DATE 'INSPECTOR
Final -------------------------- -------------------------
GATE INSPECTOR