NO PERMIT NUMBER 4l ��e.1 I `--�"t e-✓P_s�S �2P_2tf` ��d Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINb
a
_ (% F e No. /`O,OoZO
761964 / S itary No.
t' ,
Date
n lice' d f a p r t,t '
C •� v
0
to he occap ed nn as
in accordarsc, with Plot Plan, Plans and Specification filed heredith.
Estimated Valu f Improve mants S
�00
FEEE Plon Check E
Owner Address
C ontr• LAddress
Phone State Lice as
Approved /
I
- APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEES
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Dote 196 GAS FEE E
PLUMBING FEE E
Contr. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEEE
Contr. Address
Phone Siate.License
r•
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
Date Inspector
FRAME
Date Inspector
LATH & PLASTER
Date Inspector
FINAL
Date Ins oe ctor
ELECTRIC L
,OUTLETS
E CE SIZE
SWITCHES UNDERGROUND
Inspector
RECEPTACLES - 3 3o ROUGH WIRING
Date Inspector
FIXTURES � � FINISH WIRING
' H.P. CHARGE. FIXTURES to Inspector ti
ate Inspector
PERMIT FEE j' Motors q
'
date for
' TOTAL FEES FINAL C!
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE I MATERIAL
STORM DRAIN SIZE —'tATERIAL
WATER SYSTEM SIZE "MATERIAL
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 MISC
GAS DRYER PERMIT FEE
FLOOR FURNACE TOTAL FEE
INSPECTED
Date Inspector