NO PERMIT NUMBER (4) / 7 Lot No. 19
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
... File No.
` Sanitary No.
Date 196
Application is hereby made for a permit to
a story, Type
to he occupied only as
in accordance with Plot Plan, Plans and Specification filed herewith,.,
Estimated Value of Improvements. $
FEE$ Plan Check $
Owner Address
Contr. Address
Phone State License
t
.- Approved 'r
APPLICATION FOR ELECTRICAL PERMIT
Data 196 FEE$
Contr. Address
phone Sto to License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Dote Z 196• 6 GAS FEE $
PLUMBING FEF $
Contr. - Address 0711
o`
Phone 'J' State License
Approved c/e/
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEE$
Contr. Address
Phone State License
.. .. ... . Approved'. ..S.+Y�,
Applicants agree not oto`violate any of the
Workman's Compensation Laws of the
State of California
RECORD OF INSPECTION .APPROVALS
FOUNDATION BUILDING.
Date Inspector
UNDERFLOOR
FRAME Date Inspector
Do to Inspector
LATH 8 PLASTER
Date Inspector
FINAL
Date Ins De c tar
ELECTRICAL
,OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
' RECEPTACLES ROUGH WIRING Date Inspector
FIXTURES FINISH WIRING Date Inspector
Date Inspector
H.P. CHARGE FIXTURES
PERMIT FEE Motors Date Inspector
TOTAL FEES FINAL Date Inspector
_ Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE I I MATERIAL
STORM DRAIN I SIZE TERIAL
WATER SYSTEM SIZE IATERIAL
TOTAL FIXTURES . UNDERGROUND
FIXTURE FEE / PARTIAL ROUGH '
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
STORM DRAIN FEE MAIN DRAIN Date Inspector
WATER SYSTEM FEE du GAS PIPING Date Inspector
Data e r
GAS PIPING FEE - FINAL
Date Inspector
PERMIT FEE MISC
Date Inspector
TOTAL FEE � �i 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