NO PERMIT NUMBER (2) Lot No.
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, ce:;:!�'
to he occupied only y a s
in accordance with Plot Plan, Plans
and Specif tion filed herewith.,
Estimated Value of Improvements $
FEES Plon Check $
Owner qq �. Address
Contr, cL-�� — �� Address
Phone State License
Approved
pyo
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEES
Contr. 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
Dote 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
PAD FINAL
GRADING FINAL
RECORD OF INSPECTION APPROVALS -
BUILDING
FOUNDATION
Date Ins pector
UNDERFLOOR
Date Ins pector
FRAME
Do to Inspector
LATH 8 PLASTER I It 112
D eInspector
FINAL
Date V nscector
ELECTRICAL
.OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
Data Inspector
RECEPTACLES ROUGH WIRING
Date Inspector
FIXTURES FINISH WIRING
Date Inspector
H.P. CHARGE FIXTURES
Date Inspector
PERMIT FEE Motors
Date Inspector
TOTAL FEES FINAL
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE I I MATERIAL
STORM DRAIN I SIZE I L&ATERIAL
WATER SYSTEM SIZE ITERIAL
TOTAL FIXTURES UNDERGROUND -
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Data Inspector
STORM DRAIN FEE MAIN DRAIN
Date Inspector
WATER SYSTEM FEE GAS PIPING
Date Inspector
GAS PIPING FEE FINAL
Date Ias pector
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
I AGREE I WILL NOT VIOLATE ANY OF THE WORKMEN 5
COMPENSATION LAWS OF THE STATE OF CALIFORNIA.
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