NO PERMIT NUMBER (2) Lot No.
No. Street ,
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO qyh
File No. Si�/�+
Sanitary No.
Date 196
Application is hereby made for a permit to
sto;y, Type
to be occupiV only as
in accordance with Plot Plan, Plans and Specification filed herewith,
Estimated Value of Improvements j
6'V--V P D
FEES Ct)2 Plan Check $
Owner lfe-C-tiC./ Address �� // p
Contr. � p��' Address / `3 y 'a`^`�-'!"'"`+r-a-� :O G
Phone -7 '1L�� 'S`-�v State License -17�0y`sj a J
Approved
APPLICATION FOR ELECTRICAL PERMIT
Data 196 FEE$
Contr, Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Do to 196 GAS FEE $
PLUMBING FEE $
Cont,. Address
Phone 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 Laws of the
State of California
RECORD OF INSPECTION APPROVALS
FOUNDATION BUILDING
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Dote Inspector
LATH & PLASTER
a� Inspector
FINAL
Do to Ins vector
ELECTRI AL
.OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
Date 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 SIZE I lm6TERIAL
WATER SYSTEM SIZE IATERIAL
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
Dote Inspector
GAS PIPING FEE FINAL
Date Inspector
PERMIT FEE MISC
Date Inspector
TOTAL FEE MISC
Data 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 r+-
GAS DRYER PERMIT FEE
FLOOR FURNACE TOTAL FEE
INSPECTED
n..... Insneetnr t
�. I.OT N0. "
'NO, 0.EG� ..
AQP-P_- �I�Affi FOR BUILDING PERMIT
r o ®
OF
CUPERTINO
O a (JAN 10 1969 Sanitary No.
S
m LL Uate 196— ermit No.
u F @I L ati 0 is h f ermrt to
oQ
=N a story,Type Building
to be occupied only as in accordance with
0 o
Plans, Specifications and Plot-Plan filed herewith. PI Ck Fee
0 0
3 Estimated Value of Improvements, $lav Fee$
iJ It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
J Z all other laws applicable to the construction, location, and use of buildings within the City of
J o Cupertino will be complied with,
P Owner�` E'C e / Gr/9C�- Address/19 4,Z-,./
a a By •���L�t'i-,6�r� 0 5 Le-���4 C,
0 Phon k `'��'�Gy Approved
State License a 7ySoZ BUILDING INSPECTOR
A