NO PERMIT NUMBER Lot No.
No. Sfieet'
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No.
Sanitary No.
Date $ � 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 $
FEE$ Plan Check $
Owner n:!'=� Address
Contr. - Address
Phone State License
r Approved
APPLICATION FOR ELECTRICAL PERMIT
—n
Date `'3 �' 196 f7 FEES S— ,(�
Conti. Address U /A/-Ly
Phone r7 � T T 3 j State License 4
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date 3// 196 r7 GAS FEE $
_ � —� ' PLUMBING FEE $ a
Conti. � '�/ Address � O OL, A
,4
Phone L3 / 9— /l� 7 / State License J��]".,�0. ���
Approved 2n*IA-"
F�
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
FOUNDATION BUILDING _
Date Inspector w
UNDERFLOOR
Date Inspector
,FRAME
Date Ins pector
LATH & PLASTER
Date Inspector
FINAL
Date Ins oe ctor
ELECTRICAL
OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
Dote Inspector
FIXTURES FINISH WIRING
Date Inspector
H.P. CH GE FIXTURES
Date Inspector
PERMIT FEE 0 Motors
e. I DOInspector
TOTAL FEES FINAL
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE MATERIAL
WATER SYSTEM SIZE TERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Dote Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Dote Inspector
STORM DRAIN FEE MAIN DRAIN
Date Inspector
WATER SYSTEM FEE GAS PIPING
Date n
GAS PIPING FEE FINAL — _ 7
Date spector
PERMIT FEE wVU MISC
Dote Inspector
TOTAL FEE G � 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