NO PERMIT NUMBER (4) /0 7J-7 Lot No. 17
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No.j-/to t 7
Date 196 Sanitary No.�
Application is hereby made for a permit to
a - story, Type
to be occupied only as
in accordance with Plot Plan, Plans and Specification filed hcrewith�
Estimated Value of Improvements $
FEE$ Plan Check $
0wr,er !q!!
0?1!!PAA!e Address
or r
Co.tr. Address
Phone State Licen.e
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196- FEE$
Co.tr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
2/3 Do to 196 GAS FEE $
PLUMBING FEE $ !�'4 4ev
Con r. - Address /541�
V
a -I Jd 8.3 C- 3 J6 14j-
Phon State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date FEE$
Cor,tr. Address
Phone State License
Approved
Applicants agree not to'�inlate any of the
Workman's Compersatio� Laws of the
State of California
RECORD OF INSPECTION APPROVALS
FOUNDATION BUILDING
UNDERFLOOR Date Inspector
FRAME Dot. Inspector
Dote Inspector
LATH & PLASTER
FINAL Date Inspector
Do te Inso.o.,
ELECTRICAL
OUTLETS SERVICE SIZE
SWITCHES UNDERGROUND
RECEPTACLES ROUGH I WIRING Date Inspector
FIXTURES FINISH WIRING Date Inspector
Date Inspector
IXTURES
'PERMIT FEE Motors Date Inspector
TOTAL FEES FINAL Date
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE I I MATERIAL
STORM DRAIN I SIZE I LOTERIAL I
WATER SYSTEM SIZE ITERIAL
.TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH —6.—t.——7n.pe c—1.,
MAIN DRAIN FEE ROUGH COMPLETE
STORM DRAIN FEE MAIN DRAIN Date Inspector
WATER SYSTEM FEE Date I ns ps ct or
GAS PIPING
GAS PIPING FEE FINAL Dote Inspector
PERMIT FEE MISC Date Inspector
vu Date --rn—.p..—t.r
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
Do te I ns pe ctor