NO PERMIT NUMBER (2) loll / ` Lot No.
No. Street
APPLICA ION FOR BUILDING PERMIT
CITY OF CUPERTINO
+N o. I f
/ Sanitary No.
Do to v 196
Application is hereby made for a permit to
astory, Type
to be occupied only as
in accordance wi Plot Plan, plans d Specification filed herewith,
Est•iima__ted Value of Improvements § /�
FEES Plan Check $
Owner �^i
_ Address {'�_A�1rM/tr✓
Contr.
if — •r /P^'�.� Address
� .
Phone A "/I/ State License
r
Approved
APPLICATION FOR ELECTRICAL PERMIT
H
Date 196 FEES ^-
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date 196 GAS FEE $
PLUMBING FEE $
Contr.
Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Data 196 FEES
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 pector
FRAME
Date nspector
dPM 11
LATH 8 Pi AS
d>ftd$ s for
FINAL i
Dat Ins oector
ELECTRICAL
,OUTLETS SERVICE SIZE
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
Date Inspector
FIXTURES FINISH WIRING
Date nspector
H.P. CHARGE FIXTURES—
D e nspector
PERMIT FEE Motors
tar
TOTAL FEES FINAL
2 t
ata I pector
If P
PLUMBING & GAS
MAIN DRAIN SIZE I I MATERIAL
STORM DRAIN I SIZE I IMAL4TERIAL
WATER SYSTEM SIZE ITERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Date Inspector
STORM DRAIN FEE MAIN DRAIN
Date Inspector
WATER SYSTEM FEE GAS PIPING
Date Inspector
GAS PIPING FEE FINAL
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
Data Inspector