NO PERMIT NUMBER (2) r
a O X r I C:��C,Cc.,.� C(JiL s) Lot No.
No. Str
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No.
9 fi L Sanitary No.
Date / i 196
A plication ' rehy made r a 1 Mit to
y, Type
tolhe occupied only as
in actor re with Plot Plan, Plans and ecification filed herewith,
Estimated Value of Improvements $
FEEf 09 Plan Check $
Owner — Address
Contr. f Address
Phone `� I State License . ,
Approved
APPLICATION FOR ELECTRICAL PERMIT
o O J
Date O 196 FEEf
Contr. ��rr�� Address
Phone _&LS- —/P IP
State License 'J a `—
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date 196 GAS FEE f
PLUMBING FEE $
Contr. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 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
BUILDING
FOUNDATION
Dote Inspector
UNDERFLOOR
Date Inspector
FRAME
Date Inspector
LATH & PLASTER
Date Inspector
FINAL
Date Inseector
ELECTRICAL
,OUTLETS 11, 34
SERVICE SIZE
SWITCHES Z Ya UNDERGROUND
Date Inspector
RECEPTACLES' ROUGH WIRING
Date Inspector
FIXTURES L FINISH WIRING
Date Inspector
.P. CHARGEFIXTURES
Date Inspector
PERMIT FEE e Motors
' I — Dat IrIspector
TO EES d s FINAL
-t
I sp ctor
GAS.__
MAIN R IN SIZE MATERIAL
STORM AIN SIZE MATERIAL
WATER SYSTEM SIZE ITERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Date Inspector
STORM DRAIN FEE MAIN DRAIN
Date Inspector
WATER SYSTEM FEE GAS PIPING
Data Inspector
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