NO PERMIT NUMBER (4)I No.
Dote
/G(cot No.
Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
196
Application is hereby made for a permit to
a
to be occupied only as
File N . 0 10 S0�
Sanitary No.T
story, Type
in acurMn cc with Plot Plan, Plans and Specification filed herewith,
Estimated Vol+ of Improvements
FEES
Plan Check S
Owner _ L l_/ //LfA Address
Contr. ' AAA—.
Phone
Data .
Cont,.
Phone
State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
196 FEES
Address
State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Dote 196 jr- GAS FEE $
PLUMBING FEE $
Contr. Addres!/� �f7 a ,A—
Phone jZ State License
4z�t AKA?%/s2 7 V+
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEES
Contr. Address
Phone ,State License
Approved
Applicants agree not to violate any of the
Workman's Compensation Latus of the
State of California .
RECORD OF INSPECTION APPROVALS
SIZE
BUILDING
FOUNDATION
Data
Inspector
Date
STORM DRAIN
UNDERFLOOR
RECEPTACLES
Date
Inspector
Date
FRAME
H.P. CHARGE
Date
Inspector
Date
LATH & PLASTER
TOTAL FEES
Date
Inspector
Date
Date
ELECTRICAL
Inspector
Inspector
Inspector
Inspector
Ins Dector
SERVICE SIZE
UNDERGROUND
SIZE
I
,OUTLETS
Data
Inspector
SWITCHES
STORM DRAIN
SIZE
RECEPTACLES
Date
Inspector
FIXTURES
WATER SYSTEM
H.P. CHARGE
Date
Inspector
PERMIT FEE
TOTAL FIXTURES
TOTAL FEES
Date
Inspector
ELECTRICAL
Inspector
Inspector
Inspector
Inspector
Ins Dector
SERVICE SIZE
UNDERGROUND
SIZE
I
MATERIAL
Data
Inspector
ROUGH WIRING
STORM DRAIN
SIZE
REGISTERS
Date
Inspector
FINISH WIRING
WATER SYSTEM
SIZE
Date
Inspector
FIXTURES
TOTAL FIXTURES
MISC
Date
Inspector
Motors
FIXTURE FEE
MISC
Date
Ins Pe c for
FINAL
Date Inspector
PLUMBING & GAS
MAIN DRAIN
SIZE
I
MATERIAL
UNITS
FEE
CIRCULATING HEATERS
STORM DRAIN
SIZE
REGISTERS
LiaTERIAL
BLOWER FURNACES
WATER SYSTEM
SIZE
JA'TERIAL
SUSPENDED UNIT
TOTAL FIXTURES
MISC
UNDERGROUND
GAS RANGE
FIXTURE FEE
MISC
PARTIAL ROUGH
GAS DRYER
PERMIT FEE
FLOOR FURNACE
Date
Inspector
MAIN DRAIN FEE
WIC
ROUGH COMPLETE
70 5�XEZFv— OK
Dotdo
Ins r
STORM DRAIN FEE
MAIN DRAIN
Date
Insp ct or
WATER SYSTEM FEE
GAS PIPING
Date
Inspector
GAS PIPING FEE
FINAL
�
Date
Inspector
PERMIT FEE
MISC
Inspector
TOTAL FEE
T a
lea
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
PERMIT FEE
FLOOR FURNACE
TOTAL FEE
INSPECTED
Data Inspector
Bldg. Dept
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
ewer Connection , Sanitary Permit No. 4.4..-7-4 ...........
Fl Plumbing Final Plumbing Permit No. /.
Owner or Tenant ....
At .----------1.. Q-% ��- . 1� ---------
Tract
Date Connected -----------------------------
Date Final
111 7/63 -IM
P�
Lot No.
19Q7
/a 3 tJ ; A�—
No. • STNF.F.'I'
N Q
z
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPE:RTINO �`
rySanitary No.
Dare—! 7" 196—c� Permit No. /U' C� �T
Pee $ :f?e 0
Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
Address/-' z i -v O
Phone oL.';I � —J / � �y /
State License Approvedi �J
PLUMBING INSPECTOR /��
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