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NO. Si0.6y'r LOT NO._!.
w �PLIG'IF�F' OR BUILDING PERMIT
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W LL Date Ty�/ �((���ee ���pp[[DD�-I � Permit No. d I cX
o ApPkTt n 9Fcre1rVW eRTWhit to
a N a story,Type s' Building
to be occupied only as JiNCLC Af rt)/ 4NE2L/1VC
0 o in accordance with Plans, Specifications and Plot-Plan filed herewith.
t 3 Estimated Va!ue of hnpro,,ements, $_Ir.000-� Fee$ S?. 00 -
z J it is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
J z all other k,wv applicable to the construction, location, and use of buildings within the City of
d o Cupertino w
(�ill be complied with.
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Owner Address '4I, sly S-T
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0-0 Phone Approved
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State Licens 1 BUILDING INSPECTOR
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I'AGREE I WILL NOT VIOLATE ANY OF THE WORKMEN S
COMPENSATION LAWS OF THE STATE OF CALIFORNIA.
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FIX
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UNITSFE ESi1 a c.r UNITS FEES
Water Heater
Water Closets a x'� Mara'ati„�.•&.. Z.00
Oath Tubs -;N *To Curb "
Showers : moo. P'p ;Li_ne
Lavatories Z ,MO j ing
Kitchen Sinks
' Dish Washers ;Sew,e Btixx 3.00
Waste Disposals
Wash Trays S,TLORKDRAINAGE
Washing Machines Size
Water Softeners Mite IM
Bar Sinks T61 am Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
I'loor Drains ¢"A, R SYSTEMI
Hoppers =Size] �rt
Restaurant Sinks ',Ma at
San�Traps TOTAL FEES
Urinals -%Fixture Pee p•t7
Area Drains .Main Drain Fee. Op
"Water Leaders k,Stoim Drain Fee
Sprinkler Valves l•,WiCfer Sys. Fee ��_.0{
kper"rnit Fee 72, (3 C)
TOTAL }TOTAL FEE ,@�_)
RECORD OF INSPECTION
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I AGREE I WILL NOT VIOLATE ANY OF, THE WORKMEN'S
i. COMPENSATION LAWS OF THE STATE.OF CALIFORNIA.
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Remarks (Check ✓)
Type of Appliance Units Fees I New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates '
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity. Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
(NAME. TYPE)
HOUSE GAS PIPING I
Number of Outlets —7---�-Stze of Main
Gas Piping Fees
Tested and Approved ... ..^/ .p.. .....................
DATE k •[NBPEGT00.
State License L S�
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Remarks (Check ✓)
Type of Appliance Units Fees New I Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates IIS• I
Circulating Heaters
Blower Furnaces I I II I
Gas Fired Boilers I II
Warming Ovens I
Percolators
Griddles -
Steam Tables
-GfYvity Furnaces ( I_
Suspendec'Unit I II
Floor Furnace
I I II I
Miscellaneous
(NAME TYPE) I Imo'! -.>♦A
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Appliance Fees 1
Inspected and Approved
DATE. INSPECTOR
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