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Estimated Value of Improvements,$.-Z5'00(7 ' Fee$ 00
iJ It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
* i all other laws applicable to the construction, location, and use of buildings within mthe City of
J o Cupertino will be complied with.
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RECORD OF INSPECTION., APP VALS
FOUNDATION
DATE INSPECTOR,
UNDERFLOOR F '
DATE I -INSPECTOR
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LATH a PLASTER /
DATE INSPECTOR
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'FINAL GASB-
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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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Remarks (Check ✓)
Type of Appliance Units Fees II New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces /re
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
NAME TYPE)
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HOUSE GAS PIPING
Nuinber of Outlets I I 5ize of ain I - `
Gas Piping Fees I I2
Tested and Approved ... .. 1 .7. : . ..... ..._. ...................
DATE INSPECTOR
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Remarks (Check ✓)
Type of Appliance I Units Fees I New I Replace I Relocate
Gas Ranges
Wall Heaters
Gas Plates I II I I
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens. I dIR I I
Percolators I ??�t� I
Griddles 111 I I
Steam Tables IIlt I I
Gravity Furnaces
Suspended Unit
Floor.Furnace
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Misce'l'laneous I l 1
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Appliance Fees
Inspected and Appro"ve .._ _....._ ...
DATP. 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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FIXTURES NUN BER- MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closets Materia; e.T
Bath Tubs To Curb
Showers To Prop. Lin
Lavatories To
Kitchen Sinks J Conn.
Dish Washers Sewe xes
Waste Disposals
Wash Trays STORM DRAINAGE
%trashing Machines J Size
Water Softeners Material
!Bar Sinks To Main Drain
Combe.Sink &Trays To Curb
Dental (%rits
Drinking Fountains
Floor Dr ins WATER SYSTEM
Hoppers Size rt
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee 6,6
Area Drains Main Drain Fee
.Water Leaders Storm Drain Fee
Sprinkler Valvcs Water Sys. Fee
Permit Fee
TOTAL 11 TOTAL EE J 0.0
RECORD OF INSPECTI
Underground Rough—.!5
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