NO PERMIT NUMBER (4) //0Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No. 'r1101
Sanitary No.
Do to / 196 Ar
Application is hereby made for a permit to J.
a story, Type dl
to be occupied only as
in acccrdanre with Plot Plan, Plans and Specific on filed herewith,
Estimated Value of Improvements s 3c 0
FEE$ �A4 JAA. s Plan Check $
Owner
Contr. w {� Address
Phone arA -.f 7� / State License
' 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 $
Contr. 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
Dare Ins pe ctor
UNDERFLOOR
Dare Inspector
FRAME
ate Inspector
LATH 8 PLAST •
AD
Dat r
FINAL
I
E ICAL
,OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
'
FIXTURES FINISH WIRING Date Inspector
H.P. CHARGE FIXTURES Date Inspector
Date Inspector
PERMIT FEE Motors
Date Inspector
TOTAL FEES FINAL
• Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE TERIAL
WATER SYSTEM SIZE iTERIAL
TOTAL FIXTURES . UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Date Inspector
STORM DRAIN FEE MAIN DRAIN
Date Inspector
WATER SYSTEM FEE GAS PIPING
Date Inspector.
GAS PIPING FEE FINAL
Date Inspector
PERMIT FEE MISC
Dote 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
Data Inspector