5140-Z,,) / a W I ` X—L Lor No. -.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No.
_ Sanitary No.
Dare � 796
Application is hereby made for a permit to
/ It/r 2
story, Type
to be occupied only as
in accordsA with P t plan, Plans and Specific on filed herewith,
�j �Esrima ted Value of Improvements $
FEES ""' —eA� Plan Check E
Conrr. r/ r ,( 'LA� Address
Phone State Licensee
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEES
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date 196 GAS FEE $
PLUMBING FEE E
Cont,. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Data 196 FEES
�y
Contr. - - Address
Phone State License
Approved
Applicants agree not to violate any of the
Workman's Compensation Laws of the y,
State of California %,t
RECORD OF INSPECTION APPROVALS
FOUNDATION BUILDING _
Date Inspector
UNDERFLOOR
FRAME Date Inspector
Date Inspector
LATH 8 PLASTER
FINAL DyJ / Ins a for
Date I nS ae c for
ELECTRICAL
,OUTLETS SERVICE SIZE
SWITCHES UNDERGROUND
Dat, Inspector
RECEPTACLES ROUGH WIRING
FIXTURES FINISH WIRING Date Inspector
Date Inspector
N.P. CHARGE FIXTURES
Date Inspector ,
PERMIT FEE Motors
TOTAL FEES .FINAL Dote Inspector
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN I SIZE I Lli&&TERIAL
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
Data Inspector
GAS PIPING FEE FINAL
Data Inspector
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