51140 10512 LO N NA LANE
51140
F
MR & MRS C.J . COULSTON
SCANNED BOX # 709
9
/of/.Z I ✓ /L/YL Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No. 'f
Sanitary No. ZI D 3
Do to 196
Application is ereby ma or-0
a story, Type _
to be occupied only as �
in �rdance with plot Plan, Plans and Specification filed herewith,
Estimated Volye of Improvements $
FEE$ Plan Check $
Owner Address
Contr. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEES
Contr, Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Data 196 GAS FEE f
n PLUMBING FEE $ O
Eertrrr `cru-e��� Address �� S �a 'G�✓
Phone — 5� � g State License
�j
Approved
APPLICATION FOR APPLIANCE PERMIT
Data 196 FEES
Cont,. Address
Phone State License
, . Approved
Applicants agree not to violate on), of the
Workman's Compensation Laws of the
State of California
RECORD OF INSPECTION APPROVALS
FOUNDATION BUILDING
Dote Inspector '
UNDERFLOOR
Date Inspector
FRAME
Dote Inspector
LATH 8 PLASTER
Date Inspector .
FINAL
Date Insoector
ELECTRICAL
,OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
Dote Inspector
FIXTURES FINISH WIRING
'H.P. CHARGE FIXTURES Dote Inspector
_ Date Inspector
PERMIT FEE Motors
Date Inspector
TOTAL FEES FINAL
.. Date Inspector
PLUMBING 8 GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE L,6TERIAL
WATER SYSTEM SIZE / iTERIAL 7-49MS %f
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE �- a� ROUGH COMPLET
e 1 ctor
STORM DRAIN FEE - MAIN DRAIN t
Date Inspector
WATER SYSTEM FEE GAS PIPING
Date Inspector
GAS PIPING FEE FINAL
Date Inspector
PERMIT FEE ��" MISC
av 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 I
Date Inspector
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