NO PERMIT NUMBER (2) Lot No.
No.l Street ...
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO r
File No.
Date _196
Sanitary No.
�L ^)
Application is hereh made for XTo
o story, Type
to he occupiedon y as
in accordance with plot Plan, Plans and Specification filed herewith,
Estimated Value of Improvements $
FEES �Plari Check $
Owner
Contr. Address
Phone State License
Approved
r 1
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date 196 GAS FEE $
PLUMBING FEE $
Conte Address
Phone Stare License
Approved
S APP ICA TION FOR APPLIANCE PERMIT j per
Date 196 FEE$
Contr. nn �" Address V.
Phone 7.X G- 16 71 O . �$ro to License 'C-24
Approved
Applicantsagree not to violate any of the -
Workman's Compensation Laws of the
State of California
RECORD OF INSPECTION .APPROVALS
FOUNDATION BUILDING
UNDERFLOOR Date Inspector
FRAME Dote Inspector
LATH B'PLASTER Do to I ns pe ctor
Do to Inspector -
FINAL
Date Insoector
ELECTRICAL'
.OUTLETS
SERVICE SIZE'
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
FIXTURES FINISH WIRING Date Inspector
H.P. CHARGE
Date Inspector
FIXTURES '
Date Inspector
PERMIT FEE Motors
Data Ins pecfor
TOTAL FEES FINAL
Date Inspector -
PLUMBING & GAS
MAIN DRAIN SIZE I I MATERIAL
STORM DRAIN I SIZE I LowTERIAL
WATER SYSTEM SIZE ITE RIAL
TOTAL FIXTURES . UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Do f6 Inspector
STORM DRAIN FEE MAIN DRAIN
WATER SYSTEM FEE GAS PIPING Date Inspector
GAS PIPING FEE FINAL Date Inspector
Date Inspector
PERMIT FEE MISC I.
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 PERMITAE
FLOOR FURNACE TOTAL yj
INSPECTED ` 10y
Data Inspector