100049 21950 LI N DY LANE
100049
F
SCANNED BOX # 709
a / 9 So I Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
.. File No.
Sanitary No.
Date 196 W
Application is hereby made for a permit to
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/ a story, Type
to he occupied only as Com/� �
in accordance with Plot Plan, Plans and Specification filed herewith,
Estimated Value of Improvements f t,21e o �d0
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FEE$ r Plan Check $
Owner �/ Address
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/ Address a� / �'+�-eN-�-
Phone �s3 .. `� O / State License/' ) /�j7_"_� _ _ /'
Approved tom/ �/ 4417,e ^v/
APPLICATION FOR ELECTRICAL PERMIT
�y
Date / �� �`196'�— FEEf
`/ Address
Phone. - 76— / b 46 State License /
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Data 196 GAS FEE $
PLUMBING FEE f
Cont'. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEEf
Contr. 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 BUILDING
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Date Inspector
LATH & PLASTER
Date Inspector
FINAL
Date Ins Dec for
ELECTRICAL
,OUTLETS SERVICE SIZE
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES /0 ROUGH WIRING
Date Inspector
FIXTURES FINISH WIRING
-f' Date Inspector
H.P. CHARGE / FIXTURES
ate Inspector
PERMIT FEE O-ZMotors
ate ir
pector
TOTAL FEES o2' o FINAL
ate Inspector
PLUMBING 8 GAS
MAIN DRAIN SIZE I I MATERIAL
STORM DRAIN I SIZE I LIATERIAL
WATER SYSTEM SIZE 41TERIAL
TOTAL FIXTURES UNDERGROUND.
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Dote Inspector
STORM DRAIN FEE MAIN DRAIN
Date Inspector
WATER SYSTEM FEE GAS PIPING
Date Inspector
GAS PIPING FEE FINAL
Date Inspector
PERMIT FEE MISC
ate 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