NO PERMIT NUMBER (2) Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No.
Sanitary No.
Data _ 3 196
Application is hereby made for a permit to
a story, Type
to he occupied only as
in accordance with Plot plan, Plans and Specification filed herewith,
Estimated Value of Improvements $
FEES Plan Check $
Owner O Address
Contr. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date3n� , 196 FEE$
CantCG cc r/ Address 0 r v
Phone - /` O ' 7` �-j� State License /7 a �_�^j
TTC�tt
Approved vg /
APPLICATION FOR PLUMBING & GAS PERMIT
Date `� 196 ,7 GAS FEE $
- ' PLUMBING FEE E
Contr. �% /p p Address oa
Phone —�,� 0 9 7 / State License 2,eeG P46 7
Approved
APPLICATION FOR APPLIANCE PERMIT
Data 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
Do to I ns pe ctor
LATH & PLASTER
Dote Inspector
FINAL
Date Ins as c tar
ELECTRICAL
.OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
Data Inspector
RECEPTACLES ROUGH WIRING
Date Ins pacfor
FIXTU S FINISH WIRING
Date Inspector
H.P. CHARGE FIXTURES
Date Inspector
PERMIT FEE Motors
9 6-p . �1 Dqt ns pa cfor
TOTAL FEES •/ FINAL
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE MATERIAL
WATER SYSTEM SIZE ITERIAL
TOTAL FIXTURES L6 UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
- Dote Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Dote Inspector
STORM DRAIN FEE MAIN DRAIN '
Date Inspector
WATER SYSTEM FEE GAS PIPING
_�, n r
GAS PIPING FEE IS�° FINAL Dote
Date ns pactor
PERMIT FEE MISC
Date Inspector
TOTAL FEE 6 C MISC
Dote 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