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APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File N,.1—M10
Sanitary No.
Date 196
Application is hereby made for a permit to
a story, Type
to be, aecapied only as
in accordance with plot Plan, Plans and Specification filed herewith.
Estimated Value of Improvements $
FEE$ Plan Check $
Owner ✓M' / Address
Contr, Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEES
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Dote 196 GAS FEE $
PLUMBING FEE $
Cont'. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEE$
Cont'. 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
FOUNDATION BUILDLMG ..
Do to Inspector
UNDERFLOOR
out. Inspector
FRAME
Date Inspector
LATH & PLASTER _
Date Inspector
FINAL
Do to Ins no.for
ELECTRICAL
,OUTLETS SERVICE SIZE
SWITCHES UNDERGROUND
Data Inspector
RECEPTACLES ROUGH WIRING
Date Inspector
FIXTURES FINISH WIRING
Dot. Inspector
H . CHARGE FIXTURES
ate Inspector
PERMIT FEE Motors
TOTALFEES FINAL AQA
(� 0 1 ate Inspector
Do to Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE MATERIAL
WATER SYSTEM SIZE ITERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Dote Inspector
STORM DRAIN FEE MAIN DRAIN
Data Inspector
WATER SYSTEM FEE GAS PIPING
Date Inspector
GAS PIPING FEE FINAL
Date Inspector
PERMIT FEE MISC
Date Inspector
TOTAL FEE MISC
Dote 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 FE
FLOOR FURNACE TOTAL F,E E!
INSPECTED
Date Impactor
OFFICE COPY
ELECTRIC CSERVICE NOTICE
BUILDING INSPEICI'Oks OFFICE
CITY OF CUPERTIN6 I
e-
TO You are hereby auth iz f to con el a service for,
Owneror Tenant ............ . .. .. .. ----------- ....... . ...... ...... ....... ......................
At ...................10 .. . .................................
..................... ...... ...........
..- ..
Size of Wires ...... Size of Switch ..........14
No. of Wires . ......... ..... - 'A
MotorLoad .......................... Voltage ................................ Phase ..................................
Heating Load ........................ K. W. .................. ............. Volt I age ................................
ILight................ 110......... New Service....._......... Reconnect..................
No. of Meters....................
HCAL................ 220...... .... Three Wire................ Move Service............
No. of Add. Meters............
Power............... T we................ Mo Meter..............
........ ................... ... ......... .. .........
et.ecnucAL I SPE OR