NO PERMIT NUMBER (5) t
Lot No.
No. Street
APPLICATION FOR BUItLDING PERMIT
CITY OF CUPERTINO
1 ' e Na. at
99
^ Sanitary No.
Do to ��� 196 s—
Application is hereby made for a permit to
G X Lry _ story, Type
to be occupied only as
in accordance with Plot Jffan, Plans and Specification filed herewith,
V
Estimated Value of Improvements $ dy o� tb
FEES ,�V ^ Plan Check $
Owner mss/ Address 110-,
.yContr. fyAddress O3 X.
Phone - QZ .1,`ZState License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$ ca otQ
Cont,. ..s. s s
Phone �,�i2. �� / 7 State License �� .Z.
Approved •— 4.1 A i
APPLICATION FOR PLUMBING & GAS PERMIT
Data 196 GAS FEE $
PLUMBING FEE $
Cont,. Address
Phone State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Data 196 FEE$
Cont,. Address
Phone State License
Approved
Applicants agree not to violate any of the
Workman's Compensation Laws of the
State of California
RECORD 01 INSPECTION APPROVALS
FOUNDATION BUILDING
Dote Inspector
UNDERFLOOR
Date Inspector
FRAME
Date Inspector
LATH & PLASTraIle
01 0 spa ctor
FINAL
Date Ins ae c for
ELECTRICAL
,OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
Date Inspector
FIXTURES FINISH WIRING
Date Inspector
.P. GE
HCHAR / FIXTURES
Date Inspector
PERMIT FEE / !!O Motors
Dote Inspector
TOTAL FEES oZ — FINAL
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE I I MATERIAL
STORM DRAIN I SIZE I LL4TERIAL
WATER SYSTEM SIZE ITERIAL
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 Inspector
GAS PIPING FEE FINAL
Date Inspector
PERMIT FEE MISC
Date Inspector
TOTAL FEE - M_ ISC
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 __