NO PERMIT NUMBER (2) OZ-✓� T I /��bv�-t/ Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO may/
File No.y s, 7i/.1.
Sanitary No.
3
Dare , /G 196 -7—
Application is hereby made for a permit to
a story, Type
to be occupied only as
in accordance with Plot Plan, Plans and Specification filed herewith.
Estimated Value of Improvements §
FEE§ Q- - Plan Check §
Owner /�QA� l/ J Address
Contr. Address
Phone State License
Approved
1'
APPLICATION FOR ELECTRICAL PERMIT
Data 196 r7 FEE§ &S
Contr. r/ ress 7700 ,
Phone - �`LPj' �T -Ij Stu to Licons0
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date `� 196 7 GAS FEE § 117
/�� J PLUMBING FEE §
Contr. ✓Ys•✓'�) Address a
Phone State License ���d 77
Approved E&!e"
v
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
BUILDING
FOUNDATION
Dote Inspector
UNDERFLOOR
Date Inspector
FRAME
Date Inspector
LATH & PLASTER
Date Inspector
FINAL
Data Ins De ctor
ELECTRICAL
,OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES ROUGH-WIRING
Date Inspector
FIX URES FINISH WIRING
e.t Date Inspector
H,P. C ARGE FIXTURES
Date Inspector
PERMIT FEE riU Motors
uspector
TOTAL FEES 3 FINAL 1
Data Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE MATERIAL
WATER SYSTEM SIZE ITERIAL
TOTAL FIXTURES .S-�u UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Dote Inspector
MAIN DRAIN FEE ROUGH COMPLETE
' Date Ins pecbr
STORM DRAIN FEE MAIN DRAIN
Date Inspector
WATER SYSTEM FEE GAS PIPING
�—o Date Qv r
GAS PIPING FEE FINAL '�'
Date Inspector
PERMIT FEES MISC
Date Inspector
TOTAL FEE - (o � 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
GAS DRYER PERMIT FEE
FLOOR FURNACE TOTAL FEE
INSPECTED
Date Inspector