NO PERMIT NUMBER fo�.3/ �u0d► IQDIltJ LOT NO. 1
NO. STREET
APPLICATION FOR APPLIANCE PERMIT +
d z CITY OF CUPERTINO J
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L
o Date "►R 191 4 Permit No.
3 < eL
U
Fee $ 'q '400)
= 0
° Application is hereby matte to the City-of Cupertino for a peii it to
o a install gas appliances as listed on the reverse's'ide hereof, and agrees,to
<m install said appliances in accordance with the provisions of the Plumbing ri
Y = Code of the City of Cupertino, and all other laws applicable thereto.
r CO-►.n.w��tw< A.
j Use of Premises
00 1
713
50 Owner V I Sot c. Address 1013 / Aduala RtTAYi
J zBye ]G
. t n t• Address 1-17.S S- 844 a t-
'o �' CONTRAcroR, AGENT A N -JW a �7
a Phone
y
oi_ State License 141 l 4•S s Approved
1 PLUAOING INSPECTOR ��
i
APPLIANCE
UNITS FEES�.i
as op r ` erA
Gas Ovcn • ' .. '"s 1
W51I Furnace - -••'' -
•..
Gravi[Y
Forccd Air Furn. ��
Gas Fired Boilers
Warming Ovens
Suss. Units
Dwelling Kit./Bath
Inde und. Vent System
.GSm"lndust—PnsCK,it. 9 • s
Hood&Vent System
Forced Air Under 4000•CFM1f 'v
Forced.Air.Ove 4000.OW : �yi : �. 1 S •dQ
Ind. Ventilation System
(without Comfort Cool 1
Forced Air. Mech.each Power
Gravity System - Ell
Nl,No.of FluesStacks for Metal Fireplaces
Smoke Stacks,Mise. Equip.Under 15' IlighOver 15'Hiei
Comfort Cooling
Comp.of 20 PIP or less
&absorp. units with input
of 500,000 BTU or less
Comp.over 20 IIP& Under 50 til'
&Absor . units with input
of 500,001 &Under 1,000,000
41 Permit Fee Q,.a�
Total Total Fee iq ,('�.
LOT NO.
NO. STR EF.I'
APPLICATION FOR PLUMBING PERMIT
a CITY OF CUPERTINO
z
z
W p I
' 0 Sanitary No.
0 a Date 196_ Permit No
3V i
i4 Fee$
O Application is hereby made to the City ert t for a permit to install plumbing
`o < pipes and/or fixtures listed on er e er n rees to install said prices
i and/or fixtures in accordance witi� Pl ing Code of the City of Cupertino, and all other Incas ap i -tl�Pthereto.
I'd,
�. Use of Premises
00
' " - c CITY OF 0 3 Owner C})WFGp V
z_j
J o
, By -"`.'�'—'—�`-� Address 3
CONTRACTOR, AGENT n
— Phone
w Z 1
rc a
J
0a State License Approved
U 4 / PLUMBING INSPECTOR
IXI URLb NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Hath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Pee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
'Iain Drain
Final