FILE 51114S 4I .l1Q.n/iu"a" \ r Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No.
Sanitary No.
Dote196
Application is hereby ).de for a permit to jv
a
to be occupied o
in accordance with Plot Plan, plans and Specification filed herewith,
Estimated Val" of Improvements $
FEE$ - P.A. • e� Plan Check $
Owner, AAddress
Contr. �j� Address
Phone 7.�� L� State Li
Approve
Date
Contr.
Phone
APPLICATION FOR ELECTRICAL PERMIT
196 FEE$
Address
State License
Approved
,APPLICATION FOR PLUMBING &GAS PERMIT
Dote el I 196 GAS FEE $
• PLUMBIC
Contr. w -` Address 382Q/�� Q�
17
Phone 72Acy State License �� / �7 VV �-
Approved
APPLICATION FOR APPLIANCE RMIT
t I
Dobe R t 1% 71=1 7v, : cuamU?FE ES t t 11JAMXU-1 Y13W0_:8 1
I he
to L
Laws of the I 7 !
Edi �aTOT j��_ 3 3:1 Nt i AOOJ3
U3TD392W
a+n o¢aal et nG
ELECTRICAL
SERVICE SIZE
11WWATER TERIAL
UNDERGROUND
TOTAL FIXTURES
FEE
RECORD OF INSPECTION
APPROVALS
Date
REGISTERS
BUILDING
ROUGH WIRING
FOUNDATION
Date
Inspector
Date
Inspector
UNDERFLOOR
MISC .
Date
Inspector _
Date
Inspector
FRAME
Date
Inspector
Dote
PERMIT FEE
Inspector
LATH & PLASTER
Date
ctor
Date
Inspector
li FINAL
Date
Inspector
Date
Ins oe ctor
ELECTRICAL
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE MATERIAL
SYSTEM
SERVICE SIZE
11WWATER TERIAL
UNDERGROUND
TOTAL FIXTURES
FEE
UNDERGROUND
Date
REGISTERS
Inspector
ROUGH WIRING
BLOWER FURNACES
Date
Inspector
Date
Inspector
FINISH WIRING
MISC .
Date
Inspector _
Date
Inspector
FIXTURES
Date
Inspector
Date
PERMIT FEE
Inspector'
Motors
Date
ctor
Date
Inspector
FINAL
Date
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE MATERIAL
SYSTEM
SIZE
11WWATER TERIAL
TYPE OF APPLIANCE
TOTAL FIXTURES
FEE
UNDERGROUND
FIXTURE FEE
REGISTERS
PARTIAL ROUGH
BLOWER FURNACES
Date
Inspector
MAIN DRAIN FEE
ROUGH COMPLETE
MISC .
Date
Inspector _
STORM DRAIN FEE
MAIN DRAIN
MISC
Date
Inspector
WATER SYSTEM FEE
PERMIT FEE
GAS PIPING
FLOOR FURNACE
Date
ctor
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
Do to Inspector
Q
BUILDING DEPARTMENT , -
CITY OF CUPER:TINO
orrectio 'ce
job Located ar/Gr_.�7..-J..-...-
I have this d ure and these premises
and have foun t follo olations f City and/or State
reby notified that no more work shall be done
pon /� mise v violations are corrected.
Whe c6rd as /e/en a call the inspector.
Date ._r�'-- /"' . :..4z:.b......... ......................................
Inspector r p
DO NOT REMOVE THIS TAG
101 12/63-Ii11