NO PERMIT NUMBER Lot No.
No. Street
CITY OF CUPERTINO
APPLICATION FOR BUILDING PERMIT
Sanitary No.
y ' / File No. 's
Date � a 19 �
A pts hereby made for a permit to
n story, Type
to be be occupied only asa _ T C .
in accordant with plot Plan, Plans andh.,
� Specification filed herewit
Estimated Value of Improvements $ TQ 3 t
FEE$ / Plan Check $
Owner Address �/r
Contr. �AR�GAa.F�.�/ H M Address - ��a-a IO�qt, ; t7
Phone FO &P State License �3 00
r
Approved tom/
APPLICATION FOR ELECTRICAL PERMIT
Data 19 FEE$
Cant, Address
Pfrone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Data 19 GAS FEE $
PLUMBING FEE $
Contr. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 19 FEE$
Contr. Address
Phone State License
Approved
Applicants agree not to violate any of the
Workman's Compensation Latus of the
State of California
PD-1
RECORD OF INSPECTION APPROVALS
BUILDING
DATE INSPECTOR MISC.
PAD FINAL
FOUNDATION
UNDERFLOOR
FRAME
LATH & PLASTER
GRADING FINAL
FINAL BLDG.
ELECTRICAL
DATE INSPECTOR MISC.
UNDERGROUND ROUGH
ROUGH WIRING
FINISHED WIRING
FIXTURES
MOTORS
FINAL
PLUMBING, GAS & APPLIANCE
DATE INSPECTOR MISC.
BACK FLOW REQ.
SANITARY NO.
UNDERGROUND ROUGH
PARTIAL ROUGH
ROUGH COMPLETE
MAIN DRAIN
FINAL PLBG.
FINAL GAS
FINAL APPLIANCE
DATE INSPECTOR MISC.
MISC
MISC
MISC