NO PERMIT NUMBER �OSy,� dt-c CJ N� Lot No.
No. Street -
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No.yt /Oo 3
Sanitary No.
Dote � �� 196 � '
Application its hereby made for a permit to
I.�w`-moi story, Type
to he occupied only as �C4-Cs-'��:.'�,
in ace once with Plot Plan, Plans and Specification filed herewith.
Estimated Value of Improvements $ s�DO
FEES Plan Check $
Ow r.ar Address
Confr. ss 16
Phone �-r� �Kjcp rz State License
��1
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEES
Contr, Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date 196 GAS FEE $
PLUMBING FEE c
Contr. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 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
Data Inspector
UNDERFLOOR
Date Inspector
FRAME
Dote Inspector
LATH 8 PLASTER
FINAL
�3 •03;6 , 6b ,specter
i
Da to Ins oecter
ELECTRICAL
OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
Dote 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 I I MATERIAL
STORM DRAIN I SIZE I IddmTERIAL,
WATER SYSTEM SIZE IATERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Data Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Data Inspector
STORM DRAIN FEE MAIN DRAIN
Date Inspector
WATER SYSTEM FEE GAS PIPING
Data Inspector
GAS PIPING FEE FINAL
Data Inspector
PERMIT FEE MISC
ate nspector
TOTA L.FEE � '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. PERMIT FEE
FLOOR FURNACE ' t TOTAL FEE
INSPECTED
Date Inspector