25892 0 5-0,3 `� I.OT NO,
NO. STREET
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
/ Sanitary No. G
= U Dare196-196.1 Permit 196.Permit No. ,� �O
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LL F Application is hereby made for a permit to
Z N a story, Type—uildjrtg
to be occupied only as ' "z
0 o in accordance with Plans, Specifications and Plot --PIS filed herewith.
F 3 Estimated Value of Improvements, $ Z So Fee S�'o
zJ It is hereby agreed that the requirements of the Cupertino Building and Zoning Or finances and
* Z all other laws applicable to the construction, location, and use of buildings within the City of
=! o Cupertino w;ll be complied with. 0
3 ax Ownelsa' �pJ �%1_ Address
W Z
rc a By
a U \Phone -2 2- - 3 3
State License
Address
Approved w `
BUILDING INSPECTOR
RECORD OF INSPECTION APPROVALS
FOUNDATION
DATE
INSPECTOR
UNDERFLOOR
DATE
INSPECTOR
FRAME
J
DATE.
INSPECTOR
LATH and PLASTER
DATE
INSPECTOR
FINAL BLDG.
j
DATE
INSPECTOR
FINAL ELEC.
J
DATE
INSPECTOR
FINAL PLBG.
DATE
INSPECTOR
FINAL GAS
--t
DATE
INSPECTOR
�✓ �,3, I �'�� lV!^ ^ r LOT
NO. STREET
ON FOR PLUMBING PERM T •
tiara ITY OF CUPERTINO
7 /
Date A P R �62 196 - " Permit No.
CITY OF CUPERTINO Fee
Application is hereby made to the City of Cupertino for a permit to Install plumbing
\ pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a� Cupertino, and all other laws applicable thereto.
d
Use of Premises
—
a
+" Owner Address
gyAddress��
CONTRACTOR, AGENT
-f
Phone FA- �5`i' `l Approved
PLUMBING INSPECTOR
F- I UNITS I FEES 11 1 UNITS I FEES
Water Heater
Wates r Close
To
Lavatories To Existing
Kitchen Sinks
Dish Washers
N<Con2k�7.?
ES �/ 1
II SEWER BOX(/
Waste Disposals
I I
Wash Trays
STORM DRAINAGE
Washing Machines
II Size
Water Softeners
Material I
Bar Sinks
To Main Drain
Comb. Sink & Trays
To Curb
Dental Units
I
Drinking Fountains
I II
Floor Drains
I I II WATER SYSTEM
Hoppers
I I i1 Size
Restaurant Sinks
I I II Material
Sand Traps
I I II TOTAL FEES
Urinals
Fixture Fee I 3
Area Drains
Water Leaders
I I II Main Drain Fee
Storm Drain Fee
Sprin er Vatves I I 11 Water Sys. Fee
Permit Fee U
TOTAL I 11 TOTAL FEE
R CORD SPECTION
Partial Rr,agh '3 2
Rough Complete
Final ir2
J
-Cupertino Sanitary
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
Sewer Connection Sanitary Permit No. ------
Iiumbing Final Plumbing Permit No..__,4r16 ... ......
Owner or Tenant .......
4;?'20 ------ 6.2
At ..... I ... .... ... - ------
LotNo-----------------------------
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.......... ....... ------------ ....... ------------
------------------------------------
Tract
------------_....................
JLract -_-_------------ - - -- --------- qF 49 ---------------- ------------- -------------
DateConnected .................................... ------ — --------------_--_--_----- 19-4
DateFinal ............... _------------- ---------------------------
--------- - ----- - - -- ------------------- .............
NSPECTOR
In 1/60-500 LLTMBING I