NO PERMIT NUMBER (4) tit dux',J.. Alf Lot No. Y
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No. J /6B7
Sanitary No.
Date 196
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 herewith,
Estimated Value of Improvements $
FEE$ /[//�� �� Plan Check $
Owner ��^'�K./ Address
Contr. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEES
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date s'f 3 196 GAS FEE $
PLUMBING FEE $
Coatr. /����" 4 � Address 1V
Phone — �0 y`� State License,- /C j G ` ��j�/r,�✓✓
Approved
GV
APPLICATION FOR APPLIANCE PERMIT
Data 196 FEE$
I
Conti. 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
Dote Inspector
LATH & PLASTER
Dote Inspector
FINAL
Date Insoector
ELECTRICAL
,OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
RECEPTACLES ROUGH WIRING Date Inspector
FIXTURES FINISH WIRING Date Inspector
.P. CHARGE FIXTURES Date Inspector
Date Inspector
PERMIT FEE Motors
TOTAL FEES FINAL Dote Inspector
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE I I MATERIAL
STORM DRAIN I SIZE I LIaTERIAL
WATER SYSTEM SIZE ITERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE /03 PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Do td Inspector
STORM DRAIN FEE MAIN DRAIN
Date Inspector
WATER SYSTEM FEE GAS PIPING
Date Inspector
GAS PIPING FEE FINAL
Date Inspector
PERMIT FEE L� 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