NO PERMIT NUMBER (3) ®•A�D I • > r/ v -pV Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
Sanitary No.
File N9/LL—Z--
Dare / 196
Application is hereby made for a permit to
a s ry, Type
to be occupied only as
in accordance with plot Plan, Plans a d ecifi tion ed herewith,
Estimated Value of Improvements $
3 s"
FEE$ � Plan Check $
Owner �,/�y/.�® _ ti,�C. OA Address
Cont, _ F�C�G-"(a , e--c-�c,... Address
Phone a y 7 - 7e`9 7 State License / rh 7 2.0
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
Contr, Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Data 196 GAS FEE $
PLUMBING FEE $
Contr. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEE$
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
BUILDING
DATE INSPECTOR MISC.
PAD FINAL,
FOUNDATION
UNDERFLOOR
FRAME
LATH & PLASTER
GRADING FINAL
FINAL BLDG.
ELECTRICAL
DATE INSPECTOR In MISC.
UNDERGROUND ROUGH
ROUGH WIR G
FINISHE WIRI
o
09
FIXTUR S /
MOTORS. -
r 0 6 s
FINAL
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