51015 Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No. NJ %t
47 Sanitary No.
Dote 196
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Application is hereby made for a permit to
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to be occupied only as
7
in accordance Plot plan, Pla/ an Specification filed herewith,
Estimated Value of Improvements $
FEES `S � Plan Check $ p `
Owner �/ _ ' Address 0'Dra F w
Contr. K A4 ``,, Address i �J
Phone 0t . 7 T 7 State License XA��j,/��_-�/I�a� �
001
Approved �^' �'�''^A
APPLICATION FOR ELECTRICAL PERMIT
00
Dare ' � �y 1964111 FEES �
Contr. OQ. 01 Address 0�
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 196 FEE$
Contr. Address
Phone State License
f t
Approved
Applicants agree not to violate any of the
Workman's Compensation Laws of the
State of California
RECORD OF INSPECTION APPROVALS
FOUNDATION
/� BUILDING
Date Inspector
UNDERFLOOR ,p� '
FRAME I Zv
' p ct r
ote - Inspector
LATH & PLASTER
In pector
FINAL
- Date Ins oector
ELECTRICAL
.OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
L-u
RECEPTACLES ROUGH WIRING Date Inspector
FIXTURES � r "` FINISH WIRING Date Inspector
Date 4s pector
H.P. CHARGE FIXTURES
/ti Date Inspector
PERMIT-FEE '� Motors
G a � pector
TOTAL FEES - FINAL
D 'te Inspector
PLUMBING GAS
MAIN DRAIN- SIZE MATERIAL
STORM DRAIN SIZE LA,6TERIAL
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
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 1 MISC
GAS DRYER - PERMIT FEE
FLOOR FURNACE TOTAL FEE
INSPECTED
Date ( Inspector
AGREE I,WILL NOT VIOLATE ANY OF THE WORKMEN S �\
COMPENSATION LAWS OF THE STATE OF CALIFORNIA. QO
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