NO PERMIT NUMBER (2) Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No. `L
Sanitary No.
Dare 196
App�ccaat oon is hereby =- e o At�11-setor�y, ype
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to he occupied only as
in accordance with Plot Plan, Plans and Specification filed herewith„
Estimated Value of Improvements $
FEES Plan Check $
Ovrr,er �J _ /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 $
PLUMBING FEE $
Contr. _� - Address /27S-
Phone a a 7o 6 State License -120"�� `�7 —� 1
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
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Date Inspector
LATH & PLASTER
Date Ins pe ctor
FINAL
Date Insoector
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 ::::F
STORM DRAIN SIZE MATERIAL
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 Inspector
WATER SYSTEM FEE s` GAS PIPING
Date r
GAS PIPING FEE FINAL
Date pe ctor.
PERMIT FEE �'� MISC ns
Date Inspector
TOTAL FEE - 3 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
Date Inspector
!t � I OtOO TE^&E YF• LOT NO,
NO. STREET
Na CITY OF CUPERTINO
W z My of a..=`:sacs
Yo APPLICATION FOR PLUMBING PERMIT
Q— AU "
OJ 30 1973
3 Q Sanitary No.
w U Da is— J-1Permit No.
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F O u u� .. Fee$ 3
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a Application is hereby made to the Cit of Cupertino for a
City p permit to install plumbing
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m pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
w= and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a r Cupertino, and all other laws applicable thereto.
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la Premises Work To Be
Performed
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3 Q Contractor,Agent
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6 E State License Y w� / Approved
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