NO PERMIT NUMBER (2) i-j137n prnt naj
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NO. STREET LOT NO.
CITY OF CUPERTINO •50
APPLICATION FOR BUILDING PERMIT
SANITARY NO.
FILE NO. 51.,1 34
DATE 11/6/7)1 19
Applicationis hereby made for a permit to ., . . . .
Reroof o 1 story,type Tar & Gravel
to be occupied only as Single Family Dwelling
in accordance with plot plan,plans and specification filed herewith.
ESTIMATED VALUE OF IMPROVEMENTS $ 1,1100
FEE$ 14.00 PLAN CHECK$
OWNER Jacobson ADDRESS
PHONE 252-1730
CONTR, Holland Roofing ADDRESS 463 Minnesota S.J.
PHONE 293-3709, STATE LICENSE 268 766
APPROVED .L-j..ohn- A. Bnsto/h
BUILDING INSPECTION RECORD
DATE INSPECTOR DATE INSPECTOR
FOUNDATION FLOOR STEEL
PRE-GUNITE FRAME
BOND BEAMS LATH
WALLBOARDS-INT.B EXT.
FIREWALLS
MEMBRANE LANDSCAPING
F.M.O. INSPECTION
FINAL BLDG.
SEE-
MOORE
-MISC-
BUSINESS FORM5INC..IA
ELECTRICAL INSPECTION RECORD
RESIDENTIAL DATE INSPECTOR COMMERCIAL DATE INSPECTOR
UNDERGROUND ROUGH UNDERGROUND ROUGH
ROUGH WIRING ROUGH WIRING
FINISH WIRING FINISH WIRING
FIXTURES INTERIOR FIXTURES
MOTORS EXTERIOR FIXTURES
FINAL MOTORS
FINAL
MISCELLANEOUS INSPECTIONS
PLUMBING INSPECTION RECORD HEATING&A/C INSPECTION RECORD
DATE INSPECTOR DATE INSPECTOR
BACK FLOW REQUIRED UNDERFLOOR S.M.
BACK FLOW INSTALLED DUCTS&INSULATION
UNDERGROUND ROUGH FLUES&COMB.AIR
PARTIAL ROUGH CONDENSATE DRAINS
ROUGH COMPLETE FINAL APPLIANCE
ROOF DRAIN&LEADERS
MAIN DRAIN
FINAL GAS
FINAL PLUMBING
MISCELLANEOUS
/0 3 7 a �'e ten/L- i.P LOT NO. 'f
NO. STREET
CITY OF CUPERTINO { VAL. i !i p
i d city APPLICATION'FOR BUILDING PERMIT CAP t
OP FEE •S—D
F Ditto ` CUPF@TLvp 19—. Building Per,No. SJ
Y OLLy Sanitary Per.No.
3 v App at an is 0Q'f$y made for a permit to lPE'.P do
= LLO a stgry, Type T R V O'Ryri�L Structure
I
'0 fit to be occupie only as i [-c= •vw 09'5r"dance with
a
'Z 'W Plans,Specifications and Plot-Plan filed herewith.
< w <�
F Estimated Value of Improvements, S U
< u_ PI Ck Fee S
O O It is hereby agreed that the requirements of the
n Cupertino Building and Zoning Ordinances and all Fee$ S� �=
p a other laws applicable to the construction,location,and
Z use of buildings within the City of Cupertino will be Total Fee 3
ZO complied with.
3Q
cTa�A e aJ;t - X30
o< a w R r rfL�D ES08 S
ONTR.OR AGENT� ADDRESS
-3 0 2 G,f 7 6
PH NE STATE LICENSE BUILDING INSPECTOR