51104 Building Application Io.r,3 G Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO _
File 1,104 //O
Sanitary No.
Dare � � 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 $
Owr.er 0400--VId Address
Contr. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date , .� 196 d GAS FEE $ _
PLUMBING FEE $
Contr. "'�a� Address
Phone 7✓� 2OQ Q Stat. License
7 1z
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
FOUNDATION BUILDING
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Data Inspector
LATH & PLASTER
Date Inspector
FINAL
Date Ins ue c for
ELECTRICAL
;PCHARGE
TS SERVICE SIZE
ES UNDERGROUND
Date Inspector
TACLES' ROUGH WIRING
Data Inspector
RES FINISH WIRING
Date Inspector
FIXTURES
Date Inspector
T FEE Motors
Date Inspector
FEES FINAL
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE MATERIAL
WATER SYSTEM SIZE ITERIAL
TOTAL FIXTURES 43 UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Date Inspector
STORM DRAIN FEE MAIN DRAIN
' ata Inspector
WATER SYSTEM FEE GAS GAS PIPI
atctor
GAS PIPING FEE FINAL
Date Inspector
PERMIT FEElaoo, MISC
Date Inspector
TOTAL FEE G– 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
GAS DRYER - PE RMfT—FEE
FLOOR FURNACE TOTAL FEE
INSPECTED
Dote Inspector
1 C.S 3b W H I T IvE v rel / LOT NO.
NO. STREET
C, CUt`"nNq1-O CITY OF CUPERTINO
APPLICATION FOR APPLIANCE PERMIT
ir
Permit No.
Date ^ —19— Fee S (�'-v
Application is hereby made to the City of Cupertino for a permit to install gas
appliances as listed on the reverse side hereof, and agrees to install said appliances in
accordance with the provisions of the Plumbing Code of the City of Cupertino, and all
other laws applicable thereto.
Use ofWork To Ile
Premises Performed_
Owner�xd/ rJ Address c,
Phone
By Address I D �1
^Cont�rract r,Agent I
Phone
2�qYState License /✓`� T 7 Approved
Plumbing Inspector
I AGREE I WILL NOT VIOLATE ANY OF THE WORKMEN'S
COMPENSATION LAWS OF THE STATE OF CALIFORNIA.
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