NO PERMIT NUMBER Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No/00,
y Sanitary No.
Dore a Z�� 196
Appli ca t' i�s hereby made for ar t to
story, Type
to be occupied only as
7
in accordance with Plat Plan, Plans and Specification filed herewith„
Estimated Value of Improvements $
FEES / Plan Check $
Owner Address
Contr. Address
Phone State License
Approved
t
/ APPLICATION FOR ELECTRICAL PERMIT T
Date y 1 L 196 Z FEES
C ontr. / .1/ � � Address -".4
Phone G State License O 3
' Approved f
APPLICATION FOR PLUMBING & GAS PERMIT
Date 196 GAS FEE $
.PLUMBING FEE $
Contr. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEES
Contr. Address.
Phone State License
e
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
Data Ins oector
ELECTRICA
///LJJJ
///JJJ
.OUTLETS /Al�-�_�—',r SERVICE SIZE
SWITCHES UNDERGROUND
Date 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 MATERIAL
SIARMPRAIN, SIZE MATERIAL
Cm
fl, 41Y
n 1 H
u c. Iwkt%. ON &C, vc
WATER SYSTEM SIZE 1 cum`
TOTAL FIXTURES . UNDERGRO D ,
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 PIPING
Date Inspector
GAS PIPING FEE FINAL
Dote 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
FFLOOOORYFURNAC
S DRER PERMIT FEE
E OTAL FEE
INSPECTED
Date Ins pe ctor