NO PERMIT NUMBER (3)No.
Street
Lot No.
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO ��/''
File No. �L
/ Sanitary No.
Dote � � 196
Application
is hereby made for a permit to
a/ 1 Z storY. Type
e 'rte
/—
to be occupied only as K J'�
in accordance with Plot Plan, PlaVand Specification filed herewith,
Estimated Value of Improvements s ��� Q 6 d d O
FEES SA O Plan Check $
Owner a# -O' -J Address
Contr
Phone
Address
State License
Approved
61 AV
APPLICATION FOR ELECTRICAL PERMIT
3
Dote to 196-'A' FEES - /�r-
Cwtr.j ��• d" -
� � Address
Phone __a�2 _ 3— I& J!! ' State License gyp^
Approved `V��
APPLICATION FOR PLUMBING & GAS PERMIT
Date._ 196 G GAS FEE $
PLUMBING FEE E gE. A
etsntr. k4" A�L � Address
Phone - et -s 3 �.1 9 State License
Approved
APPLICATION FOR APPLIAN PERMIT
Date 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
RECORD OF INSPECTION APPROVALS
BUILDING
FOUNDATION
."
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DATE
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DATE
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