1866 /03.5�O o"Y/ /fS Y
LOT NO. /
YC igR BUILDING PERMIT
'! JUL', 966i UPERT[NO UQ.
7Z) .
195— Permit No. 1d- L
ApG1 /cTYbnFre r�CPv=1NQnitto 64EC7
a QN` story,Type �• �- J Building
A at 301.2,- SF7 Sy6p. /R.S 0/Y9i>zS AZ4>/
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� to be occupied only as .S/r/GLC �Nr'+i[y �WEZLiNC– i
in accordance with Plans, Specifications and Plot-Plan filed herewith.
Estimated Vilue of lmprovements,$ /5000 ` Fee$ 4;5
It is hereby agreed that the requirements of*the Cupertino-Building and Zoning Ordinances and
all other laws applicable to the construction, location, and use of buildings within the City of
Cupertino will be complied with.,�
Owners/l7zCiCHy✓� Adaress .55-6 Na/A
By Address-
, CONTRACTOR, AGENT
Phone e " ZS-41A Approved
t BUILDING I SPECTO
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FIXTURES NUMBER MAIN DRAIN
UNITS I FEES 11 ;L 1UNITSI FEES
Water Heater I / iI Size 'JAL" I / 'su i
Water Closets v Material L' I
Bath Tubs / To Curb
Showers f ; ��„ II To Prop. Lincvj I
Lavatories 2,T, To Hi ' ting
Kitchen Sinks N t on z.
Dish Washers ,. / I.8 eoxEs I 3.w
Waste Disposals j 1 11
Wash Trays STORM DRAINAGE
Washing Machines / Size
Water Softeners11 Material
Bar Sinks .. II ToLMain Drain
Comb. Sink s Trays 11 ToLCurb
Dental Units II _
Drinking Fountains) li --�
Floor Drains WAT R SYSTEM
Hoppers Si /
Restaurant Sinks D1at;�al r ,�/ i /.a c
Sand Traps W T TAL FEES
Urinals Fix�ure Fee //.00 .
Area Drains Ma n Drain Fee s oo
Water Leaders 11 StCrrm Drain Fee
Sprinkler Valves Water Sys. Fee I /.m0
Permit Fee
TOTAL / TOTAL FEE ,
ECO D OF CTION
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Rough Complete
Final
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Remarks (Check d)
Type of Appliance (Units Fees II New I Replace Relocate
Gas Ranges I 11
Wall Heaters 1
Ga Plates I 1 11 1 I
Circulating Heaters*
Blower Furnaces I 1 1 I
Gas Fired Boilers 1 I I 1-
Warming Ovens 1
Percolators I I � I �
Griddles I I I I �
Steam Tables I I 11 I I
Gravity Furnaces . 1, I
Suspended Unit I II I I
Floor Furnace I 1 11 �
I-111
I
Miscellaneous i� 1
NAME TYPE) 1 I 1 I
III II III II 11
II II II IIS-I
Fees—
pp lance I II I I i'/
Inspected and Approved "....... ............. _.........._... .ter......
DATE. INSPECTOR
HOUSE GAS PIPING �`
' Number of Outlets I 1/ I Size of Main I lam
Gas Piping Fees I fSo
. Tested and Approved . .1. . i...l..... .. ......:.....
DATE INSPECTOR r«"
State License
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Remarks (Check d)
Type of Appliance Units Fees New I Replace Relocate
Gas Ranges I II
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers I l
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces,
Suspended Unit II _
_Floor Furnace
I I II I
Miscellaneous
NAME TYPE)
a aurtt P •ys I� II
I I II I
I I II•� , I: � „ i ,��:
pp lance Fees
Inspected and Approved ........................
DATE. INSPECTOR
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