NO PERMIT NUMBER (2) ''�Oyv/l G/fA'�s !, Lot No.
No. Street,, .
APPLICATION FOR BUILDING PERMIT
CITY OF.CUPERTINO
File No.
Sanitary No.
Dote �T196 '
Application is hereby made for a permit to
a story, Type
l`o'be occupied only as
in accordance with Plot Plan, Plans and Specification filed herewith,
Estimated Value of Improvements $
FEE$ Plan'Check $
Ow r,er Address'
Contr, Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Dote 196 FEE$
Contr. Addrese'
Phone State License
Approved
APPLICATION FOR-PLUMBING & GAS PERMIT
Date �� 196 I GAS FEE $
�_ �- I PLUMBING FEE $ gra D^
Contr. pp,, ;yyf���yC� Address YZ
Phone � State License
Approved706�046, — •ice`/'
APPLICATION FOR APPLIANCE PERMIT
196 196 FEE$
Contr. Address
Phone ^ '
' Sttita-License
Approved
Applicants agree not to violate any of the,
Workman's Compensation Laws of the
State of California 'l
i
i
RECORD OF INSPECTION ,APPROVALS
FOUNDATION BUILDING "
Date Inspector
UNDERFLOOR
Dote Inspector
FRAME
Date . Inspector -
LATH.& PLASTER
Date Inspector ..
FINAL
,. Date Inspector ...
ELECTRICAL
,OUTLETS
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 "I
TOTAL FEES FINAL
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE I MATERIAL
STORM DRAIN SIZE TERIAL
WATER SYSTEM SIZE iTERIAL
TOTAL FIXTURES . UNDERGROUND
FIXTURE FEE - 019 PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Date Inspector
STORM DRAIN FEE MAIN DRAIN
Date Inspector
WATER SYSTEM FEE �� GAS PIPING
- / y ate I r
GAS PIPING FEE FINAL !6—Is—dote.3-66 '
Date Inspector
PERMIT FEE G� 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
SUSPENDEDUNIT MISC
GAS RANGE' MISC
GAS DRYER PE RMIT FEE '
FLOOR FURNACE C TOTAL FEE
INSPECTED'
Date _ Inspector _
I AGREE I WILL NOT VIOLATE ANY OF THE WORKMEN'S -
COMPENSATION LAWS OF THE STATE OF CALIFORNIA. \
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UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
W0i Trays KW.ATER.SYS5TEJ
DRAINAGE
Washing Machines
Water Softeners
Bar Sinks Drain
Com . Sink s Trays
Dental Units
Drinking Fountainsi
Floor Drains Y5TEM
Hoppers Restaurant Sinks -San Traps TAL FEESUrinals e' �y e
re DDrains Main Drain Fee
YrerLeaders - Storm Drain Fee
Sprinkler Valves Water Sys. Fee p p
Permit Feed cJ
TOTAL � TOTAL FEE 0
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough Complete.. -
Main Drain
Final...