1766 !i Als 0~2> COt1RT Lor NO. 51-6 77 -
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® 1 OR BUILDING PER 1T
JUN 8 U' F CUPERTINO tict J/� 1
Date 6 K Z , J~� -Permit No. �b L
isB869hp �permit to CI?e'e T
a- �I r, story,
JJ1T�rYp�e(� J _ Building
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U. at �QrhF/e.SET cSU{']�/. .�ffS QivlJiiS Why
to be occ pied only as S v F(e- f.9 I c //o F!e
.V) in accordance with Plans, Specifications and Plot-Plan-filed herewith.
\ Estimated Value of Improvements,$ 14 O do. 00 Fee$ S7 oo _
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a 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
;j 'upertino will he complied with.
Owner D/ Z ' �'�/a'/v r Address5'S6-N
/ By �L�v N� fi�fJir c.r Address r!
/ {O AC[ZIR AGENT
Phone C`,7- �J S y/y/ Approved
LBUILDING IN PECTOR
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FIXTURES NUMBER MAIN RAIN
UNITS I FEES 11 JUNITSI FEES
Water Heater Size - j / /,Od
Water Closets i Material e /
Bath Tubs I To Curb
Showers / II To Prop. Line.-r I
Lavatories j I To Exis '
Kitchen Sinks / No C nn. ?
Dish Washers j I SEWER BOXES LtY
Waste Disposals /
Wash Trays ( Ij STORM DRAINAGE
Washing Machines / 11 Size
Water Softeners _3 Ij .Material I j
Bar Sinks g II VTo Main Drain I
Comb. Sink.a4Trays To Curb
Dental Units
Drinking Fountains) ' II
Floor Drains ; `WATER SYSTEM
Hoppers I Size
Restaurant Sinks ,. 4atenal / /,a
Sand Traps T TAL FEES
Urinals II?"Fixture Fee
Area Drains j jIS;Main Drain Fee
Water Leaders 'si JIFStorm Drain Fee j
Sprinkler Varves Ilk Water Sys. Fee
II:? Permit Fee j /, Bfl
TOTAL I /3j :, II TOTAL FEE y
RECORD O INSPECTION
Partial Rou
Rough Compl e p'
Final
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Remarks (Check d):�
Type of Appliance I Units Fees II New Replace Relocate
Gas'Ranges
Wall Heaters
Gas Plates If/ 2
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens 110
Percolators, Q �7'
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit � � I
Floor Furnace
Miscellaneous
NAME TYPE) I II
pp Iance Fees f "i4K
inspected and Approved...—........... ........................ �...
INSPECTOR
HOUSE GAS PIPINGS, .' ,;':�•t- �.',� � '«'
Number of Outlets Size'of. Main
Gu Piping Fees I s'-
Tested and Approved .. . . 1�.,!'�... .. ............................
DATE INSPECTOR
\, � tate License �697�f�
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TNpe of Appliance I Units Fees II New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating-HcatersI 1 11 1
Blower Furnaces -- I-XI7
Gas Fired Boilers
Warming—OvensI I 11 .k
Percolators
Griddles
Steam Tables
GrR'vity Furnaces
Suspended Unit'., ,, ^�
Floor Furnace
Miscellaneous
NAME TYPE
Appliance Fees �—
Inspected and Approved .J. //..E .'....... _ .:................................
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DATE RR INSPECTOR
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