6410 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LD1 NG PROJECT 1 DENTI FICATI ON PERMIT NUMBER
BULGING APPLICATION &PERMIT _ 6410
AooREss
400 ll . BUILDING-ELECTRICAL-PLUMBING-MECHANICAL '
OWNER'5 PLAN CHECK VALIDATION
NAME
c DTY. ELECTRIC PERMIT FEE '
PHON J
CONTRACTORS UTTS-SWITCHES-RECEP 5.00/1:00
NAME
sec.rvo. LIGHTILENG F IXTURES 5.00/1.00
CONTRACTOR'S
ooREu PPLIANCES-RESIDENTIAL 4.00
A
PHONE PANELS 5.00 DATE OF APPLICATION
ARCHITECT, SIGNS 600 PLAN CHECK FEE I P.C.NO.
OR
ENGINEER MA
LIC.No. SIGNS TRANS. 3.00
ADDRESS E c. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
zip TEMP.METER OR POLE INS. 15.00
APPLICANTS MOTORS - SEE FEE SCH.
ADDRESS I
SERVICE CHANGE 10.00
o o LICENSED CONTRACTORS DECLARATION
a i W I hemhy affirm Ileal I ant licensed under provisinus of Chapter 9 ISSUANCE DATE
a o (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F N z Professions Code,and my license is in full force and effect. ❑ ❑ ❑
z 0 w - License ClassLic.Number _
g F Date Comtmctor
< y s BUILDING PERMIT
w< OWNER-BUILDER'DECLARATION - - - 1 FORMATION
K
g LL I hcrcny affirm the] I am cxlintpt from the Com ractor's Liccnx MISC.- REFER TO ORD
_0 j
CITY OF CUPERTINO INSPECTION RECORD
/
(OFFICE COPY)
PER1,UT NO. ADDRESS
242�-!OOWNER
PERMIT ISSUED - DATE ELECTRICAL DATE INSP.
ui
ectnca
Plunbing Power Pole '
mcnanical Underground
Te as ec RoUgh WITMg
Solar Walls
Fire Spr=ler Ceiling
Sign Fixtures nt xt
otors
Misc. Groundm
e ower
Other
FINAL INSPECTIONS DATE INSP. Not Approved
Gas
Electric
Plumbing PLUMBING DATE INSP.
.Mechanicai
o ar Backflow
0o r un
ra m oor
Pianning Partial u
Fire t. u ete
ea t t. Solar u
1 mg ater ' Insulation
Other m am
77-67=n
Gas
Other
BUILDING DATE INSP. Not rove
Pad Certification
Foundation ELECTRICAL DATE INSP.
Pre-Gunite
Slab-Membrane Underfloor S.M.
Bond Beam wcts nsulation
Underfloor Girders Fire ers
Floor Steel Fireplace
ie owns urease Buct & Hood
is rams One Hour Shaft
eismecracing Condensate ram
Wafrs ane1 ui ment Anchorage
Frame ues 4 Ucmb. Air
�tt er
1 r oar nt ct. of 7 Fp rove
irewa s
Other
Not rove R i z _ co No . Q ti /C v J 7.�7gf. a
BUILDING
40
ELECTRICAL
PLUMBING
MECHANICAL
DffSCELLANEOUS
L