NO PERMIT NUMBER . �
ola a �J
Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No...S"� &. p
Sanitary No.L40
Data 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 ""' �`-�
ypy J ' Address
Contr, Address
Phone State License
Approved
1\� K
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING 8 GAS PERMIT
Dote/0? —oZa 196 3_ GAS FEE $
h — PLUMBING FEF
Cant', Address 4�-r�s—/S/'-w/'�+"- �
Phone elSoZ - at33 6 State License — X" 9 T'Z
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
FOUNDATION
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Date Inspector
LATH & PLASTER
Date Inspector
FINAL
Date Ins oector
ELECTRICAL
.OUTLETS SERVICE SIZE
SWITCHES UNDERGROUND —
Dote Inspector
RECEPTACLES ROUGH WIRING
Date Inspector
FIXTURES FINISH WIRING
Date Inspector
H.P. CHARGE FIXTURES
Date Inspector
PERMIT FEE Motors
Date Inspector
TOTAL FEES FINAL
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE I MATERIAL
STORM DRAIN SIZE ATE RIAL
WATER SYSTEM SIZE IATERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Data Inspector
MAIN DRAIN FEE 4 ROUGH COMPLETE
Datd
STORM DRAIN FEE MAIN DRAIN / 30
Dole Inspector
WATER SYSTEM FEE GAS PIPING
Date Inspector
GAS PIPING FEE FINAL
Sao Date 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
net. Inspector
Bldg. Dept
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
. .....
F-1 Sewer Connection Sanitary Permit .... ..
Plumbing Permit No. ---d-11- -?-9......
.2-"PIumbing Final
Lot No. .... .............
Owneror Tenant ----- ................................................. ...................
........................
... ...... ..........
At . ...
Tract ...................................................... ............. ------------ ------- ---- -- --- ------ ----------------
DateConnected ------------------------ -- -------------------------------- ................
DateFinal ------------------- -----------/-2-7-724- ------- ----- ------ ------- ---- ---------------- 19.
...................
PLUMBING INSPECTOR
III 7/63-IM
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LOT NO.
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w � ` �� � �'APPGI�t3AN 'AOR PLUMBING PERMIT
C[ r+ r� ITY OF CUP GRTINO / �L
r o /DLC ? O 1965 Sanitary No. 4�G `f
o alopCC, 196E1 �+�+ U 1� j�� Iq6Permit No
3 V bf r ui P IIV V7� Pee $—
I W
' o Application is hereby made to the City of Cupertino for a permitto install plumbing
o r pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r r`- and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other Imus applicable thereto. L
wrcrT,ivL (S u1 P R / V r ��
0 o Use of Premises �P
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3 Owner! Address 1041-&-A"0
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Z By/ vfR�Sf4 �' � l - �.ve Address fiN
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3 F CONTRACT R, AGENT
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Phone 1S1-1336 ,
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License Appro�
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