NO PERMIT NUMBER (3)/Q e�/ / I Vrrr✓ i/ Lot No.
r
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No.
Sanitary No.
Date 196
Application is hereby made for a permit to
a story, Type
to be occupied only as
in accordance with Plot Plan, Plans and Specification filed herewith,
Estimted Value of Improvements $
FEE$ Plan Check $
0wr.er Address
C ontr. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
Cont,. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date 196 GAS FEE $
PLUMBING FEE S
Contr. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 1% 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
DATE INSPECTOR
UNDERFLOOR
DATE INSPECTOR
FRAME
DATE INSPECTOR
LATH 8 PLASTER
DATE INSPECTOR
FINAL
DATE INSPECTOR
ELECTRICAL
ELECT. SERVICE
DATE INSPECTOR
UNDERGROUND
DATE INSPECTOR
ROUGH WIRING
DATE INSPECTOR
FINISH WIRING _
DATE INSPECTOR
FIXTURES
DATE INSPECTOR --
MOTORS
DATE INSPECTOR
FINAL
DATE INSPECTOR
'1 -26-to 1 TA�c,e.rn ro
J.T DRwP� /o:soA►! Ca+caxN�NG•
CAVAww- polL «'sieurb 0f jo£wl"
"vi diva. W14 13tfiPN .7,
PLUMBING & GAS
UNDERGROUND
DATE INSPECTOR
PARTIAL ROUQH
W MAr I cav&o-rw riiAr wokS NcgT V INSPECT R
4
"ROUG9tOM PL E TE�'Z6 - 70 -y IwHR•T 4MJ filer jbrl4 .�
D TE INSPEC OR
MAIN DRAIN
DATE INSPECTOR
GAS PIPING
DATE INSPECTOR
FINAL
DATE INSPECTOR
MISC
DATE INSPECTOR
MISC
DATE INSPECTOR
APPLIANCE }I
INSPECTED +'
DATE INSPECTOR _
MISC
DATE INSPECTOR
MISC _
DATE y INSPECTOR
MISC
� DATE INSPECTOR
TE`M/PGRAWY GAS SERVICE
DATE: '......`/TC.......................................... ree: .-`..........-
..........
J 2�:s'i c-r/✓ ti
JANAT: ... r ✓ .... ... ............. .................... .............................
C
LO.T: ... _ _
iT
REASON: Y�� r!A Ll/�1//r. rF11�9/fil f/7/z
The undersigned agrees to be responsible for the gas service at the above location,
until the building is ready for occupancy, and is released by the Building Department,
City of Cupertino.
PhoneG �:.....................................
- - . . .....:....... ............... ........./..:. ........................
]Nsf5EcrOR TENANT OR OWNER
117 1/63-56d..