NO PERMIT NUMBER (2) Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No.
Sanitary No.
Date 196 /
Appli Lion is het y made for u mit to
u story, Type
to he occupied onn.t.d
accordan.ewit Plot Plan, Plans and Specification filed herewith,Estilue of Improvements $
FEES Plan Check $
Owner �/� '"1-t�"U Address
Cont,. Address
Phone, State Licansa'
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEES
Contr. Address
Phone State License
Approved
?P7
TV60f
TFpN W4PLU[NBING & GAS PERMIT
'9a i.
Dare1 196 GAS FEE $
61TY 0 CU TiNO PLUMBING FEE $
Contr. UC-(� p� /d" `-a��d Add,.serye/--v/�-L-/O'�'U
Phone �// 3 / �� State License' /7 / fTa
WILLIAM D. CiENEVICH
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEES
Contr. Address
Phone State License
Y
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
Do to I ns pe ctor
LATH & PLASTER
FINAL Data Inspector
Date Insoector
ELECTRICAL
.OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
RECEPTACLES ROUGH WIRING Date Inspector
FIXTURES FINISH WIRING Date Inspector
H.P. CHARGE FIXTURES Date Inspector
Date Inspector
PERMIT FEE Motors
TOTAL FEES FINAL Date Inspector
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN I SIZE TERIAL
WATER SYSTEM SIZE ITERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE oZ� PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Da t6
STORM DRAIN FEE MAIN DRAIN 6—/
WATER SYSTEM FEE GAS PIPING Date 614spector
GAS PIPING FEE FINAL
Date Inspector
PERMIT FEE MISC
p--J 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
d ,a
GAS DRYER PERMIT FEE
FLOOR FURNACE TOTAL FEE
INSPECTED
Data Inspector
11187 I (_/NzA V /STA Y R LOT NO.
NO. STREET
a APPLICATION FOR APPLIANCE PERMIT
Z CITY OF CUPERTINO
a
MLLo 1970 �-, �3
0 Da e�L tib— Permit No. 7
P
3 u M n R q ((�� Fee S 00
0 rf, Rlicition�is�Are y�nitixle to the City-of Cupertino for a permit to
o a install gas appliances as listed on the reverse side hereof, and agrees to
¢��Il a1�� � rdance with the provisions of the Plumbing
Wbcle che`Git �( ISino and all other laws applicable thereto.
S r Use of Premises QES/D6n1GE
00 /
0 OwnerMop lnqAl S, ` o HIU-<64 Address �� 6AVA V/57P PR.
04
z ..ea+2 VAu-�Y HcgT/AIG ddress 38 N/ l�J T/tST
By 29 crG�ZZ /
; <
Sq-,OU �c�E
— w PhoneWz
02 State License_ �`S o `r7 D Approved
Q O/� PLUMBING INSPECTOR
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