NO PERMIT NUMBER (3) Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF"CUPERTINO
.Sanitary No.
' File No.
Dote 4 L 196 If
Application is hereby made for a permit to
a story, Type
to be occupied only as
in accordance with plot Plan, Plans and Specification filed herewith.,
Estimated Value of Improvements . $
FEE$ �+ Pion Check $
Owner C Address
Contr. Address '
Phone aZ T '`-d —a C� State License ' )
Approved �C/�
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEES
Contr, Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date 196 GAS FEE $
PLUMBING FEE $
Contr.. Address
Phone State _
L iee nsa
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEE$
Canty. Address
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
BUILDING
DATE INSPECTOR MISC.
PAD FINAL
FOUNDATION
UNDERFLOOR
FRAME
LATH & PLASTER
GRADING FINAL
FINAL BLDG.
ELECTRICAL
DATE INSPECTOR MISC.
UNDERGROUND RO H
ROUGH WIRING
FINISHED WIRING
FIXTURES
MOTORS
FINAL LIM'
PLUMBING, GAS & APPLIANCE
DATE INSPECTOR MISC.
BACK FLOW REq.
SANITARY N0.
UNDERGROUND ROUGH
PARTIAL ROUGH
ROUGH COMPLETE
MAIN DRAIN
FINAL PLBG. -
FINAL GAS
FINAL APPLIANCE
DATE INSPECTOR MISC.
MISC
MISC
MISC
t
N.Q NO. STREET LOT NO.
S tt Q
ELECTRICAL PERMIT
3U .f s�P 2� 969 C OF, CUPLRTINO
='o.
' Date 19' — Permit No, `�/ d
V W
I Y OF PUPERTINO het S G
` a Ap i hon Is ere y made to the City of Cupertino for a permit to install electrical
r wiring:and/or fixtures as listed on the reverse side hereof, and agrees to install said
o'o wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
> N City of Cupertino, and all other laws applicable thereto.
03
o a
z J Use of Premises
J.0
J G �/ n,I
3 m Owner Y, F /'Ire /y F ? e4 'e- Address
w w By Address
0q - CONTRACTOR,
a AGENT
Approved
Phone: -Z¢S —S{—O,-
ELECTRICAL INSPPC701 //K
State License,
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