NO PERMIT NUMBER Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No.
Sanitary No.
Dare 196
Applico ion i. here by nod fora permit t
a story, Type
to he occupied only as
in accordance tvith Plot Plan, Plans and Specification filed herewith,
Estimated Value of Improvements $
FEES / Plan Check $
Owner Address
Contr. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Data 196 FEES
Contr. Address
Phone State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date / 7� 196 GAS FEE $ Sy
PLUMBING FEE $
Contr. _ Address
Phone —T9 ,1-a So 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
BUILDING
FOUNDATION
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Date Inspector
LATH & PLASTER
Date Inspector
FINAL
Date Insoector
ELECTRICAL
,OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
Data Inspector
RECEPTACLES ROUGH WIRING
Date 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 MATERIAL
STORM DRAIN SIZE MATERIAL
WATER SYSTEM SIZE IA I TERIAL
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 r
GAS PIPING FEE FINAL/— —
Data Ins pacfor
PERMIT FEE oZ= 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
�D7'O c/ /,GfE!//LLE AdF' r OT NO.
NO. STREET
N Q
z p ION FOR BUILDING PERMIT
: CITY
OF CUPERTINO
p Stmitsrp No.
3�
i V 196—
u. nFe_rmit No. -��Z/O
oa
Applicatiis e-ypei--
'n h permit to
> I J /(/f{� Building
< ,a a
sit
` w * 2(.�at� rr7d l✓k�ff�Q6�P
r to be,pcLpied only asp ordance with
a
0 o Plans, Specifications and Plot-Plan filed herewith. P] Ck Fee
> N
> 3 Estimated Value of Improvements, SLS 4 Fee Z `�
z J It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
J z all other laws applicable to the construction, location, and use of buildings within the City of
2 o Cupertino will be complied with. O —
3 a Owner O7_-e!'y✓� Address ��
N
z
B/
tr Address
tea
7E
0 Phone 3 Approv
State License ING INSPECION