NO PERMIT NUMBER (2) No. Street'
APPLICATLON FOR BUILDING PERMIT
CITY OF CUPERTINO
File Nof ?
Sanitary No.
Date 196
t' is hereby ma or a permit to
rj
a story, Type
to be occupie l as
in accordance with Plot Plan, Plans and Specification filed herewith.
Estimated Value of Improvements $
FEE$ y /�1 ® / Plan Check $
Owr.er S��-A-it� rkll " -t�a�WAddress
Contr. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date F /21 196 GAS FEE $
PLUMBING FEE $
Contr. Vtl-'4(� Address`s 7
Phone �/ .33 7 o State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEE$
Contr. Address
Phone State License
Approved
Applicants agree not to violate any of the
Workman's Compensation Law's of the
State of California
i
RECORD OF INSPECTION APPROVALS
FOUNDATION BUILDING
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Do to Inspector
LATH & PLASTER
Date Inspector
FINAL
Do to Ins cector
ELECTRICAL
,OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
Date Inspector
FIXTURES FINISH WIRING
Do to Inspector
H.P. CHARGE FIXTURES
Date Inspector
PERMIT FEE Motors
Date Inspector -
TOTAL FEES FINAL
Date Inspector
PLUMBING ✓3< GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE taii.ATERIAL
i
WATER SYSTEM SIZE 4TERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Do t9 Inspector
STORM DRAIN FEE MAIN DRAIN
0-� Date Inspector
WATER SYSTEM FEE GAS I PIPING
Date Inspector
GAS PIPING FEE FINAL
Date Inspector
PERMIT FEE MISC
MISC
Date Inspector
TOTAL FEE d! 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
Data Inspector
Lot No.
No. Street -
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No.
Sanitary No.
Dare � ! � 196
Application is hereby made for a permit to
a story, Type
to be occupied only as � t�J
in accordance with Plot Plan, Plans and Specification,filed herewith,
Estimated Value of Improvements $
/.S-0 0 d
a
FEES 9 a'� Plan Check $
Ownar ass
Contr. wl/ ^%, "'^/" Address 2/ 7 ��
Phone - c?, `T/ '` S—7` State License
Approved WILLIAt'JI D. l3ZNEVICi4,
APPLICATION FOR ELECTRICAL PERMIT
Data 196 FEE$
Cont'. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date 196 GAS FEE $
PLUMBING FEE $
Contr. Address
,
Phone State License
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
BUILDING
FOUNDATION
DATE INSPECTOR
UNDERFLOOR
DATE INSPECTOR
FRAME
DATE INSPECTOR
LATH & PLASTER
ATE INSPECTOR
FINAL -
DATE INSPECTOR
ELECTRICAL
ELECT. SERVICE
DATE INSPECTOR
UNDERGROUND
DATE INSPECTOR
ROUGH WIRING
DATE INSPECTOR
FINISH WIRING
DATE INSPECTOR
FIXTURES
'DATE INSPECTOR
MOTORS
T INSPEC TOP
FINAL
DA E INSPECTOR
PLUMBING,& GAS
UNDERGROUND_
DATE INSPECTOR
PARTIAL ROUGH
DATE INSPECTOR
ROUGH COMPLETE
DATE INSPECTOR
MAIN DRAIN
DATE INSPECTOR
GAS PIPING
DATE INSPECTOR
FINAL
DATE INSPECTOR
MISC
DATE INSPECTOR
MISC
DATE INSPECTOR
APPLIANCE
INSPECTED
DATE INSPECTOR
MISC
DATE INSPECTOR
MISC
DATE INSPECTOR
MISC
DATE INSPECTOR
, _n will not +* any athe __e
Compensation laws a the State«California
.
,
0 !
o
} }
{ �ƒ | 0 ` ® k
J ~ / :
% §
o c ƒ§ �
> E,
\ 0 I ! ~ \
_ \ ��
# % }/ 14) E � �
on c ;
' / / �
� ` ` §
I AGREE I WILL NOT VIOLATE
HE WORKMEN S
COMPENSATION LAWS OF rCALIFORNIA.
�
-
»
Im
( £ c
2
}n ® n
/ \ \ \} \\ @s �
-
\ - » 8 &
)
/ j io
In
} �
F
a a o
§ .
° z
\ � ® � - )
o Ĥ } { IA
°
. %
,i75
rIXTUREi NUN, BER MAIN
UNITS FEES UNITS FEES
Water Heater Size
Water C oset., Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kite ems— Not Conn.
Dish Washer, Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
'skater Softeners ap Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drin —.ng Fountains
Floor Drains WATER SYSTEM _
Hoppers Size
Restaurant Sinks Material
San raps TOTAL FEES
rinals Fixture Fee
rem Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Vaives Water Sys, Fee 0
Permit Fee
TOTAL TOTALFEE
RECORD OF INSPECTION
Underground Rough...
.Partial Rnugh.
,Rough. Compli
ee..
x1ain Drain
Final...