NO PERMIT NUMBER oL0.3 / I „ �e�ry(/ DKK/ /w� �� ' Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY PE TINO
File Nova- 0XIF
Sanitary No. y464.a,
Dote 6
App 'cation i reby made for a permit to
a story, Type
to be occupied vdfVas
in accordance with Plot Plan, Plans and Specification filed herewith„
Estimated Value of Improvements $
FEES ��� ''JJ'�' Plan Check $
Owner �(N /F4n,ti� � Address
Contr. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEES
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Dote 196 Je7 GAS FEE $
PLUMBING FEE S
Contr. Address is Y p e4ZA, AW,
Phone x-96 16 State License / � �6 41
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
. Lo
RECORD OF INSPECTION APPROVALS
FOUNDATION BUILDING
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Date Inspector
LATH & PLASTER
_ Date Inspector
FINAL
Data Inspector
ELECTRICAL
,OUTLETS.
SERVICE SIZE
SWITCHES UNDERGROUND
Dote Inspector i
RECEPTACLES ROUGH WIRING
Date Inspector
FIXTURES FINISH WIRING
Date Inspector
H.P. CHARGE FIXTURES
Date Inspector
PERMIT FEE Motors
Date Inspector
TOTAL FEES FINAL
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN I SIZE I LOMTERIAL
WATER SYSTEM SIZE ITERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Data Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Do to Inspector
STORM DRAIN FEE MAIN DRAIN ANP
Date ns ector
WATER SYSTEM FEE GAS PIPING
D or
GAS PIPING FEE FINAL I'
Mao
Inspector
PER_ MIT FEE 40 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
fjlfi.e C'py
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
� Sewer Connection Sanitary Permit No. ..... ----------
EK<,�Mbing Final Plumbing Permit No. ................................
LotNo. ................................
tt
Owner or Tenant ............... ... ...? -117
--------- .......................
At .................. >91---- ---------Sv- -------- .. . .......
L --"I - ----------------------------------
Tract .......
Date Connected ..---------------------------11
... --T---- .................
Date Final ------------------------------------ ki —
19Q.....
---------- --------------- ------------ -- ------------ --------
Ill 7/63-IM PLUMBING INSP R