NO PERMIT NUMBER Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO 7
File No.
Sanitary No.
Date /. a� a7 196 1.�
pa
Application is hereby made for a permit to
eLg 0-:tdJ )QS a a story, Type
to +a occupied only as
in accordance with Plat Plan, Plans and Specification filed herewith„
pS
00
Estimated Value of Improvements $ Cz
FEE$ ty� Plan Check $
Ownar Address `LLn1�3S oST �A
C ontr. Qm. / g-al-
Phone 7C7 — Yg:Z9 cor':170-e License goo,
St
t
Approved WILLIAM D. BENEVICH
i
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEES
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Data 196 GAS FEE $
PLUMBING FEE $
Cont,. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEE$
Contr. Address
Phone ��` State License
Approved
Applicants agree not to vialate�any of the
Workman's Compensation !aws of the
State of California ;J""p `�
RECORD OF INSPECTION -APPROVALS -- - -
FOUNDATION BUILDING
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Dote Inspector
LATH & PLASTER
Date Inspector
FINAL
Date Insoector
ELECTRICAL
,OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
Date Inspector
FIXTURES FINISH WIRING
H.P. CHARGE FIXTURES Date Inspector
Date Inspector
PERMIT FEE Motors
Date Inspector
TOTAL FEES FINAL
Data Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE MATERIAL
WATER SYSTEM SIZE ``,�AT ERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Dote Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Date Inspector
STORM DRAIN FEE MAIN DRAIN
Date Inspector
WATER SYSTEM FEE GAS PIPING
Date ector
GAS PIPING FEE INAL 'Vr'
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