NO PERMIT NUMBER (2) Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No.lDU, d 03
Sanitary No.
Dote 196
Appljcation is hereby made for a per&W tom,. /lam
st ry, Type
to be oon('ly as
I SfrrP 2 nn RA, plan, Plans and,4pecification filed herewith„
C �s d�p`y0 p( I�araonents $
FEE$ - uU�t//ttK ll�''�NNv\U!1 Plan Check $
Owner _ VN..0-P�r� (�.C.C.[�at.�Jh--! Address
Contr. _�. L('' " Address o�-4
Phone
�srx � �-5 i/ (1 State License a d
Approved NIILLIPJA D. MENEVICH
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date 196 GAS FEE $
PLUMBING FEE $
Contr. Address
It IJ
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEES
Contr. Address
i
Phone State License
Approved
Applicants agree not to violate any of the
Workman's Compensation Laws of the
State of California
RECORD OF INSPECTION APPROVALS
FOUNDATION BUILDING
Date Inspector-
UNDERFLOOR
Date Inspector
FRAME
Date Inspector
LATH & PLASTER
FINAL V
Rotor 44M pector
�
Date Ins Dector
ELECTRICAL
,OUTLETS SERVICE SIZE
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
Date Inspector
FIXTURES FINISH WIRING
H.P, CHARGE FIXTURES Date Inspector
Date Inspector
PERMIT FEE Motors
Date Inspector
TOTAL FEES FINAL
Date Inspector
PLUMBING & GAS ,
MAIN DRAIN SIZE I I MATERIAL
STORM DRAIN I SIZE I ldwTERIAL
WATER SYSTEM SIZE IATERIAL
TOTAL FIXTURES . UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Date Inspector
STORM DRAIN FEE MAIN DRAIN
Date Inspector
WATER SYSTEM FEE GAS PIPING
Date Inspector
GAS PIPING FEE FINAL
Date Inspector
PERMIT FEE MISC
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 PERMIT FEE
FLOOR FURNACE TOTAL FEE
INSPECTED
Date Inspector ___