51043.1-C5_ 20975 I VALLEY GREEN DRIVE Lat No.0-5
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
Dote 196
Application is hereby made for a permit to
a
to be occupied only as
FEE$
Owner
Contr.
Phone
File No. 5104.1
San ito ry
story, Type
in accordance with Plot Plan, Plans and Specification filed herewith,.
Estimated Value of Improvements
$
Plan Check $
Address
Address
Stote License
Approved _
APPLICATION FOR ELECTRICAL PERMIT
Date 196
FEES
Contr.
Address
Phone
State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Dote 196
GAS FEE $
PLUMBING FEE $ _
Contr.
Address
Phone
State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Data 196
FEES
Contr•
Address
Phone
State License
Approved
Applicants agree not to violate any of the
Workman's Compensation Laws of the
State of California
RECORD OF INSPECTION APPROVALS
FOUNDATION
—
BUILDING
MATERIAL
Date
STORM DRAIN
Inspector
UNDERFLOOR
FIXTURES
REGISTERS
H.P. CHARGE
Inspector
Date
FRAME
COMBUSTION VENT
FIXTURE FEE
PARTIAL ROUGH
MAIN DRAIN FEE
MISC
Date
ROUGH COMPLETE
Date
STORM DRAIN FEE
Inspector
LATH ,& PLASTER
Inspector
WATER SYSTEM FEE
Inspector
Date
GAS PIPING FEE
FINAL
Date
FINAL
Inspector
PERMIT FEE
Date
MISC
Inspector
TOTAL FEE -
Date
Insoectar
Inspector
ELECTRICAL
UNDERGROUND
ROUGH WIRING ,
FINISH WIRING_
FIXTURES
Motors
FINAL
SERVICE SIZE
Data Inspector
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
Date Inspector
PLUMBING & GAS
MAIN DRAIN
SIZE
.OUTLETS
MATERIAL
SWITCHES
STORM DRAIN
RECEPTACLES
FIXTURES
REGISTERS
H.P. CHARGE
ITERIAL
PERMIT FEE
TOTAL FEES
COMBUSTION VENT
UNDERGROUND
ROUGH WIRING ,
FINISH WIRING_
FIXTURES
Motors
FINAL
SERVICE SIZE
Data Inspector
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
Date Inspector
PLUMBING & GAS
MAIN DRAIN
SIZE
FEE
MATERIAL
UNITS
STORM DRAIN
SIZE
MATERIAL
REGISTERS
WATER SYSTEM SIZE
ITERIAL
TOTAL FIXTURES
UNDERGROUND
COMBUSTION VENT
FIXTURE FEE
PARTIAL ROUGH
MAIN DRAIN FEE
MISC
Date
ROUGH COMPLETE
Inspector
STORM DRAIN FEE
Date
MAIN DRAIN
Inspector
WATER SYSTEM FEE
Date
GAS PIPING
Inspector
GAS PIPING FEE
PERMIT FEE
Date
FINAL
Inspector
PERMIT FEE
Date
MISC
Inspector
TOTAL FEE -
Date
MISC
Inspector
vale. ins pe clot
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
Dare
Inspector