NO PERMIT NUMBER �Ek I oZot )At-,d 21��
Lot No.
No. Street T
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
Fila No.ls�
L Sanitary No.
Date 196
Application ' e eby a or permit to
a story, Type
to be occupied my a.
in accordance with PLot Plan, Plans and Specification filed herewith,
Estimated Value of Improvements $
FEE$ / Pion Check $
Owner Address
Contr. Address
Phone State License
. , Approved
APPLICATION FOR ELECTRICAL PERMIT
Data 196 .. � FEE$
Contr. Address
Phone State License
Approved
APPLICATION.FOR PLUMBING & GAS PERMIT
Date 196 14" _ GAS FEE $
n �A PLUMBING FEE $ /�A,
Contr. / Address 1' a- v"
Phone rC;z N �� State License
Approved
c
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEES
Cont,. Address
Phone State License
•� Approved
Applicants agree not toviolate 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
FIXTURES FINISH WIRING Date Inspector
Date Inspector
_]
H.P. CHARGE FIXTURES '
Date Inspector
PERMIT FEE Motors
Date Inspector
TOTAL FEES FINAL
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE I I MATERIAL
STORM DRAIN I SIZE I lmIL4TERIAL---F—
WATER SYSTEM SIZE IATE.RIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Do td Inspector
STORM DRAIN FEE MAIN DRAIN
Date Inspector
WATER SYSTEM FEE GASP NG1 11
GAS PIPING FEE � FINAL
tZ� D ttor
Date Inspector
PERMIT FEE MISC
Date Inspector
TOTAL FEE MISC
Data 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 r
GAS DRYER PERMIT FEE '?
FLOOR FURNACE TOTAL FEE
INSPECTED
Date Inspector
ALA
LOT NO.
APPLICATI OR PLUMBING PERMIT
w i , FEE 8 1965 OF CUPIiRTINO
x o Sanitary No.
o -1 [�T��� r
3 a Dat f�'FFtV I�»L( ' lit No p
W LL Pee $
2 0
� Application 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
> r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws applicable thereto.
w x
� r
Use of Premises
0 3 Owner �� 1 Address ��0d r
Z gy 2 eta Address Sin f r(""''
G CO
3 ` k4TRAc}'OR, AGENT
� 5 Z0 �3
— `m Phone /97/,
a of 1 State License ` �tl i 7-Approve
s
_U T PLUMBING INSPECTOR
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