NO PERMIT NUMBER i
Lor No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No./O Or, D
I Sanitary No.
Dare _.�_196 `
Application is hereby made for a permit to
/AsVtiY./arr.r`/ a / story. Type
to be occupied only as
in accordance with Plo an, Plans and Sp kation filed herewith,
T.Z167
Estimated Value of Improvements $ at
FEE$ � - Plan Check $
Owner [ MrMT�A's�'N'4r�l ress
Conir. OAddress
Phone Gr37-ii �� State License Ap �
� r
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
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
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 Califnmia
RECORD OF INSPECTION APPROVALS
BUILDING
FOUNDATION
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Date Ins pector
LATH & PLASTER
atm ctor
FINAL
Date Insoector
ELECTRICAL
,OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
Date Inspector
FIXTURES FINISH WIRING
Data Inspector
H.P. CHARGE FIXTURES
Date Inspector
PERMIT FEE Motors
Date Inspector
TOTAL FEES FINAL
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE I MATERIAL
STORM DRAIN SIZE 1906L4TERIAL
WATER SYSTEM SIZE IATERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Date Inspector
STORM DRAIN FEE MAIN DRAIN
Date Ina pe ct or
WATER SYSTEM FEE GAS PIPING
Date Inspector
GAS PIPING FEE FINAL
Date Inspector
PERMIT FEE MISC
Dote-- Inspector
TOTAL FEE MISC
• Date Inspector
APPLIANCE
TYPE OF APPLIANCE UNITS FEE TYPE OF APPLIANCE UNJTS FEE
CIRCULATING HEATERS REGISTERS
BLOWER FURNACES COMBUSTION VENT
SUSPENDED UNIT MISC
GAS RANGE MISC
GAS DRYER PERMIT FEE
FLOOR FURNACE TOTAL FEE
INSPECTED
n r Ins no c for