NO PERMIT NUMBER (2)l A C
^A% 003�) IkS w i%'1J Lot No. d
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO `
File No., III ti
s
Q]� Sanitary No.
Do to 196`r
Application is hereby made for a permit to
E-zpp�KicAT— _ _ a for Type
to be occupied only as J � A b
in accordance with Plot Plan, Plans and Specification filed herewith.
Estimated Value of Improvements § ZOO
FEES �Oy P��\p\n Check $
0,vr.er �IlTZ W"* 9%)ILt ►J o bass A'S
Cont'. Address
Phone State License, r
Approved LN —J 11
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING 8 GAS PERMIT
Data 196 - GAS FEE $
PLUMBING FEE $
Contr. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE 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
FOUNDATION BUILDING
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Date Inspector
LATH & PLASTER
®_Do� p- s e for
FINAL O
Date Ins Dector
ELECTRICAL
,OUTLETS SERVICE SIZE
SWITCHES UNDERGROUND
RECEPTACLES ROUGH WIRING Date Inspector
FIXTURES FINISH WIRING Date Inspector
H,P, CHARGE FIXTURES Date Inspector
PERMIT FEE Motors Date Inspector
TOTAL FEES FINAL Dote Inspector
Data Inspector
PLUMBING & GAS
MAIN DRAIN SIZE I MATERIAL
STORM DRAIN SIZE j MATERIAL
WATER SYSTEM SIZE IATERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
-
STORM DRAIN FEE MAIN DRAIN Dote Inspector
Date Inspector
WATER SYSTEM FEE GAS PIPING
GAS PIPING FEE FINAL Date Inspector
Date 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