NO PERMIT NUMBER'xQ G �7 M��,� /� Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No.
Sanitary No.
Date 196
Application ' hereby made for ape to
a story, Type
to be occupied on1 as
in accordance with Piot Plan, Plans and Specification filed herewith„
Estimated Value of Improvements S
O Q
FEES Plan Check $
OwnerQ -� Address
Contr. EZ�r^'^-'�/ - Address
Phone 3 7 .f'- 3'L State License�ca Lo�� 'J�.f�
Approved .meq
.a
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEES
Contr. Address
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 FEES
Contr. Address
Phone State License
c..
c� Approved
Applicants agree not to {ifolate 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 8 PLASTER
Dare Inspector
FINAL
Date Ins De c for
ELECTRICAL
,OUTLETS SERVICE SIZE
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
Date Inspector
FIXTURES FINISH WIRING
Date Inspector
H.P. CHARGE FIXTURES
Data Inspector
E FEE MotoraDateInspactor
FEES FINAL
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE MATERIAL
WATER SYSTEM SIZE IATERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Do to pe r
STORM DRAIN FEE MAIN DgRAIINN,�/�® - O"C
tomn P
WATER SYSTEM FEE
Date I Spector
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
Bldg. Dept.
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
Sewer Connection Ey o.
E],—Plumbing Final Plumbing Permit No. ........_._...............
Lot
o- ----------------------------
Lot No. ---- - ------- ---------
Owner or Tenant -----
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Tract
- - --- - --- ------Tract ------ ------------------...--------------------------/--------------------
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- --------------------- -------------------------- -- ------------------------------ -----------
Date Connected ..... yy
------,...,//D,.Z"-;---------------------------------- ----------------------- 19
Date Final ------ --------------------9A ...
-- ----------------------------- -------------------------
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111 12/664M ;OPLUMBING INSPECTOR