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NO PERMIT NUMBER (4)I No. Street APPLICATION FOR BUILDING PERMIT CITY OF CUPERTINO Date 196 ;,Z— Application is hereby to be occupied only as Lot No. File No. �JJI IV So n ito ry �for a permit ��to�� �� � a�"^"�-ftory, Type in accordance with PlorPlan, Plans and Specification filed herewith, Estimated Value of Improvements s DE d 0 FEES Plan Check $ Owner Address ` Contr. Address Ph one Z. I- —�2 5e9 G State License Approved r y^ 2z I IV s APPLICATION FOR ELECTRICAL PERMIT Data s 196 FEES i n GmteT, Address k--7 an. - S 3"' oZ��y State License Approved APPLICATION FOR PLUMBING & GAS PERMIT Date 196 Contr. Phone Date Contr. Phone GAS FEE $ PLUMBING FEE $ Address State License Approved APPLICATION FOR APPLIANCE PERMIT 196 FEES Applicants agree not to violate any of the Workman's Compensation Laws of the State of California Address State License Approved RECORD OF INSPECTION APPROVALS FOUNDATION BUILDING Date UNDERFLOOR Date , FRAME Date LATH & PLASTER CFINAL I& - Date I n's pe ctor ,. -'Ins pector' Inspector Inspector WATER SYSTEM ELECTRICAL - TERIAL ,OUTLETS TOTAL FIXTURES SERVICE SIZE FIXTURE FEE SWITCHES UNDERGROUND Date Inspector MAIN DRAIN FEE Do to Inspector RECEPTACLES ROUGH WIRING Inspector STORM DRAIN FEE MAIN DRAIN Date Inspector FIXTURES FINISH WIRING GAS PIPING , Date Date Inspector ' H, P. CHARGE, FIXTURES FLOOR FURNACE Date Inspector , PERMIT FEE Date Inspector PERMIT FEE Motors ,Inspector . TOTAL FEE MISC i p nspactor TOTAL FEES FINAL V Date Inspector - PLUMBING & GAS MAIN DRAIN SIZE MATERIAL r 1 STORM DRAIN SIZE MATERIAL WATER SYSTEM SIZE - TERIAL UNITS TOTAL FIXTURES .UNDERGROUND FIXTURE FEE PARTIAL ROUGH Date Inspector MAIN DRAIN FEE ROUGH COMPLETE Do td"' Inspector STORM DRAIN FEE MAIN DRAIN ' Data Inspector WATER SYSTEM FEE GAS PIPING , Date Inspector GAS PIPING FEE FINAL FLOOR FURNACE Date Inspector , PERMIT FEE MISC Date ,Inspector . TOTAL FEE MISC Vote 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 TOTAL FEE ' INSPECTED Date Inspector NO I AGREE I WILL NOT VIOLATE ANY OF THE NA'ORKMEN S COMPENSA�joN LAWS OF THE STATE OF CALIFORNIA. � �� y ° Q}2%��; � b� 0 © = \ I 0(/ r G N±ZZ \\0 �� f§ > > > mkz - ± ■ ■ y J - % § § _ � � ��