51132 Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO r,
File No.—S ,/20L
Sanitary No.
Dote 196
Application is hereby made for a permit to
a story, Type
to be occupied only as
in accordance with plot plan, Plans and Specification filed herewith,
Estimated Value of Improvements $
FEES Plan Check $
Owr.erAddress
Contr. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Data 196 FEE$
Contr. Address
Phone Store License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date 196 21� GAS FEE $
''J1
PLUMBINGFEE $ / (�
Cont,. Address V mf7/
IV
Phone r2 AOC/—,3-370 State License/'J2 3 S[� .�—�•
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 1% FEES
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 Insoector
ELECTRICAL
.OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
Date Inspector
FIXTURES FINISH WIRING
' M.P. CHARGE FIXTURES Date Inspector
Date Inspector
PERMIT FEE Motors
Date Inspector
_TOTAL FEES FINAL
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE I I MATERIAL
STORM DRAIN I SIZE TERIAL
WATER SYSTEM SIZE ITERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE �� PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
- Do to Inspector
STORM DRAIN FEE MAIN DRAIN
Date Inspector
WATER SYSTEM FEE �� GAS PIPIN
ate nspector
GAS PIPING FEE � FINAL 69 A
Data Inspector
PERMIT FEE MISC
Date 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
Dote Inspector
1/71120 '/� dt� ��Ly COT NO,
NO. S
® Pim, C - T FOR PLUMBING PERMIT
a Y OF CUPERTINO
x 0 OV 16 1965 Sanitary No.
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0 a Dnte /�ZJ— 196*r Permit No
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CITY OF CUPERTINO
o Fee $ �-
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� pp kation is hereby made to the City of Cupertino for a permit to install plumbing
oa 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 w Cupertino, and all other laws applicable thereto.
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LL Use of Premises
00
0 3 Address
Owner i-<-c.,�eJ r2+,.-..-�-.-✓
�o By Uli .� //<.Y � Address �y
< Phone `��
ao State Licens �3yry` _ Approved '
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'I. R -S NUMBER MAIN R I
UNITS FEES UNITSI FEES
Water Heater Size
Wee, Closets Ma'era'_
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
..Washing Machines Size
"NX'kteJ Softeners Gd Material
Bar Sin -s. To Main Drain
Comb. ,Sink a Trays To Curb
Dent:d Units
Drinking Fountains
Floor Drains WATER SYSTEM'
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
\X/ater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL y pa TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
.Partial Rough__
Rough Complete..
.)-Iain Drain
Final...
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