NO PERMIT NUMBER (8)/ 0 3.2o I / A�n.C.-y.c,-
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
No.
Fife No. a -F
Sanitary No.
Date �� jf 196 G
Application . he by made for a permit to
a story Type
to be occupied only as • •.
in accordance with Plot plan, P ns and Specification ried herewith„
J� M�
Estimated Value of Improvements i
FEE$ 01'f-
Plan Check $
Owner ��' w'�^ A•as s / O 3 O
Contr.•� w�� ///��) ��_ /.��5/ ,Adds
Phone lams State License����%% ar
Approved W-&21
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
Contr, Address
Phone State License
Approved
t.
APPLICATION FOR PLUMBING & GAS PERMIT
Date 196 GAS FEE $
PLUMBING FEE $
1
Contr. Addressf
Phone State License
1. Approved
APPLICATION FOR APPLIANCE PERMIT
Dote 196 FEES
Contr. Address
Phone Stdte License
Approved
Applicants agree not to violate any of the
Workman's Compensation Laws of the
State of California
RECORD OF INSPECTION
APPROVALS
I I MATERIAL
.OUTLETS
STORM DRAIN
BUILDING
SWITCHES
FOUNDATION
Do to
RECEPTACLES
Inspector
ROUGH WIRING
Do to)
Date
'Inspector
UNDERFLOOR
PERMIT FEE
FINISH WIRING
TOTAL FEES
Date
Inspector
Data
I ns pe ctor
FRAME
FIXTURES
" Date
Inspector
Do to
r,
PERMIT FEE
Inspector
Inspector
LATH 8 PLASTER
Date
Inspector
Data
Date
FINAL
ettor
FINAL
01
PERMIT FEE
MISC
Date
Insoe ctor
Inspector
TOTAL FEE
ELECTRICAL
MISC
Date Inspector
PLUMBING & GAS
MAIN DRAIN
SERVICE SIZE
I I MATERIAL
.OUTLETS
STORM DRAIN
I SIZE
SWITCHES
Do to
RECEPTACLES
Inspector
ROUGH WIRING
FIXTURES
Date
H.P. CHARGE
Date
PERMIT FEE
FINISH WIRING
TOTAL FEES
Date
Inspector
Date Inspector
PLUMBING & GAS
MAIN DRAIN
SERVICE SIZE
I I MATERIAL
UNDERGROUND
STORM DRAIN
I SIZE
I imhLATERIAL
Do to
REGISTERS
Inspector
ROUGH WIRING
BLOWER FURNACES
Date
Inspector
Date
Inspector
FINISH WIRING
MISC
Date
Inspector
Data
Inspector
FIXTURES
" Date
Inspector
Date
r,
PERMIT FEE
Inspector
Motors
Date
Inspector
Data
Inspector
FINAL
Date
Date Inspector
PLUMBING & GAS
MAIN DRAIN
I SIZE
I I MATERIAL
TYPE OF APPLIANCE
STORM DRAIN
I SIZE
I imhLATERIAL
WATER SYSTEM
SIZE
ATERIAL
TYPE OF APPLIANCE
TOTAL FIXTURES
FEE
UNDERGROUND
FIXTURE FEE
REGISTERS
PARTIAL ROUGH
BLOWER FURNACES
Date
Inspector
MAIN DRAIN FEE
ROUGH COMPLETE
MISC
Date
Inspector
STORM DRAIN FEE
MAIN DRAIN
MISC
" Date
Inspector
WATER SYSTEM FEE
r,
PERMIT FEE
GAS PIPING
FLOOR FURNACE
Date
Inspector
GAS PIPING FEE
FINAL
Date
Inspector
PERMIT FEE
MISC
Date
Inspector
TOTAL FEE
MISC
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
r,
PERMIT FEE
FLOOR FURNACE
TOTAL FEE
INSPECTED
Data -- Inspector