51119 /s/✓�i �y I s/{/. V_�y Lot No.
No. Street
<BU APPLICATION FOT
CITYOFFile No.rCAMP
anitary No.
Date 196
Application ismheeby a fstory, Type
to be occupied on y a,s
i accordance V
lot Plan, Plans and Specification filed herewith„
Estima Value of Improvements $
FEES Plan Check $
Owner Address
Contr. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEES
Contr. Address
Phone ``
® State License
qnc p f Approved
a m 4084'L _��NG & GAS PERMIT
Date 196 GAS FEE $
ITY OF CUP �RT�NG �/^PLUMBING FEE i
Contr. ^ )rdress ,
Phone 202 State License
I ' Approved
APPLICATION FOR APPLIANCE PERMIT
Date 1% FEE$
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
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Date Inspector
LATH & PLASTER
Data Inspector
FINAL
Date Ins oector
ELECTRICAL
.OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
Dote Inspector
FIXTURES FINISH WIRING
Date Inspector
H.P. CHARGE FIXTURES
Date Inspector
PERMIE
Motors
Date Inspector
TOTA5 FINAL
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE TERIAL
WATER SYSTEM SIZE tITERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Dote Inspector
STORM DRAIN FEE MAIN DRAIN
Date Inspector
WATER SYSTEM FEE GAS PIPING
_—Date for
GAS PIPING FEE FINAL
Date spector
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 1�
Date Inspector
LOT NO. A.
NO. MEET
APPLICATION FOR PLUMBING PERMIT
z a CITY OF CUPERTINO
i
W
y
LLO Sanitary No.
� r
0 < Date az '2 0—Ic- lgb Permit No
U p o
= W Fee $
O Application is hereby made to the City of Cupertino for a permit to install plumbing
o < pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
W Cupertino, and all other laws applicable thereto.
W x
J LL Use of Premises {QHS
20
oa Owner �'-,-F6P L'ZCI&�V4- Address
zJ
o By L /N O S o9 ✓ Wo r 41y7E,C Address .��/ 1"n Ibei n.5rr
F coNrxncP6R,nGEtsr syry 7 osE
w Phony. g J"9 - ey 9 �' _
W z
aoState License--Ql a/�o91� Approved
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PLUMBING INSPE&OR
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