NO PERMIT NUMBER (8)c�>
No. Street V
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
Do to 196 G
Ap iicatian is ereby made for a per t
a
to be occupied n ly s
in accordance with Plot Plan,
Estimated Vale, of Improvements $
FEES _ _ , Plan Check $
Ow r.er lV`f./
�'rT-�`"� Address
Contr. Address
Phone State License
Approved
l:
File � Q
Sanitary
Specification filed herewith„
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEES
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date 196 GAS FEE $
PLUMBING FEE S
Contr. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT js
Data�^ 196 b FEES
Z^'rM•l Address 40 S'0
Phone - b S'C)L ' if 5/J -IC State License
Approved
Applicants agree not to violate any of Blue
Workman's Compensation Laws of the
State of California
RECORD OF INSPECTION
APPROVALS -
TERIAL
FOUNDATION
TOTAL FIXTURES
BUILDING
SWITCHES
Date
RECEPTACLES
Inspector
ROUGH WIRING
FIXTURES
Date
Date
H.P. CHARGE
Inspector
UNDERFLOOR
PERMIT FEE
FINISH WIRING
TOTAL FEES
Date
Inspector
Date
Inspector
FIXTURES
Date
Date
Inspector
FRAME
PERMIT FE
Inspector
Motors
Date
Inspector
Date
Date
FINAL
Inspector
LATH & PLASTER
Date
Inspector
PERMIT FEE
Dote
Inspector
FINAL
Date
Inspector
TOTAL FEE
Date
Insoector
ELECTRICAL
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE MATERIAL
WATER SYSTEM
SERVICE SIZE
TERIAL
OUTLETS
TOTAL FIXTURES
FEE
SWITCHES
Date
RECEPTACLES
Inspector
ROUGH WIRING
FIXTURES
Date
H.P. CHARGE
Date
PERMIT FEE
FINISH WIRING
TOTAL FEES
Date
Inspector
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE MATERIAL
WATER SYSTEM
SERVICE SIZE
TERIAL
UNDERGROUND
TOTAL FIXTURES
FEE
UNDERGROUND
Date
REGISTERS
Inspector
ROUGH WIRING
BLOWER FURNACES
Date
Inspector
Date
Inspector
FINISH WIRING
MISC
Date
Inspector
Date
Inspector
FIXTURES
Date
Inspector
Date
PERMIT FE
Inspector
Motors
Date
Inspector
Date
Inspector
FINAL
Date
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE MATERIAL
WATER SYSTEM
SIZE
TERIAL
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
PERMIT FE
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
PERMIT FE
FLOOR FURNACE
TOTAL F
o�Z a2
INSPECTED I ( �y I '� 1 (-),Vz
Date Inspector