NO PERMIT NUMBER (3) Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No.
Sanitary No.
Date 196 /y
A plicatby made for permit to
a y, Type
to be occupied only as
in accordance with P of Plan, Plans and Specification filed herewith.,
Estimated Value of Improvements $
FEE$ Plan Check $
Owner dress
Contr. Address
Phone State License
Approved WILLIAM D. BENEV1CHt
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
Contr. Address
Phone State License
Approved
..y�APPLICATION FOR PLUMBING & GAS PERMIT
Date 1L/ 196 GAS FEE $
PLUMBING FEE $ 4d-y
Contr. _ / � �'� t�J Address
Phone —.3S` � �� .� State License/ f—`t
Approved l.�C.l � _ .�✓
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEES
Contr. Address
Phone State License
Approved
Applicants agree not to violate any of the
Workman's Compensation Lows of the
State of California
RECORD OF INSPECTION APPROVALS
FOUNDATION BUILDING
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Date Inspector
LATH & PLASTER
Date Inspector
FINAL
Date Insoector
ELECTRICAL
,OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
Data Inspector
RECEPTACLES ROUGH WIRING
Date Inspector
FIXTURES FINISH WIRING
H.P, CHARGE FIXTURES Date Inspector
Date' Inspector .
PERMIT FEE Motors
Date Inspector
TOTAL FEES FINAL
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE MATERIAL
WATER SYSTE
M SIZE ITERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Dote Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Date Inspector
STORM DRAIN FEE MAIN DRAIN
Date Inspector
WATER SYSTEM FEE GAS PIPING
hGDo/ te Ins ct
GAS PIPING FEE FINAL �S _
Data
PERMIT FEE o2f' MISC n p or
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 t TOTAL FEE
INSPECTED
Date Inspector