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R° BUILDING PERMIT
° 5C-UrxRTINO �� ,�.�oa 1863 Sanitary No-�_
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„ ' Da '2��pT RII , 1963 Permit No: i2 6
oca is yhth$d�No permit to
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to be occupied only as
o o in accordance with Plans, Specifications and Plot-Plan filed herewith.
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i J It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
z all other laws applicable to the construction, location, and use of buildings within the City of
d o Cupertino will be complied with.
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i, State Licens �s�7 BUILDING INSPECTOR I `
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I AGREE I W, L NO`T VIOLATE ANY OF THE WORKMEN'S
COMPENSAT ON�LA'S OF THE STATE OF CALIFORNIA.
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Remarks (Check J)
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)
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HOUSE GAS PIPING
Number of Outlets Si a of ;.. A
Gas Piping Fees y �''
Tested and Approved _.. �.7. ...J.�.... .. ..._...............�........
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Type of Appliance—I Units�;Fees (Ch
II New I Replace I Relocate.
Gas Ranges
Wall Heaters
Gas Plates I I II I
Circulating Heaters I 14,ai II I I
Blower Furnaces
Gas Fired Boilers
Warming Ovens I II I I
Percolators �_ I
Griddles F'
Steam Tables I II I I —
Gravity Furnaces
Suspended'Unit I II
Floor Furnace I I II
Miscellaneous
NAME TYPE)
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pp lance ees s �—
inspected and A ro"v '
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State License 12422
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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 NUb1BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heatcr Size (J� 4CJ
Water Closets ,2 -Materia!
Bath Tubs / To Curb
Showers /q To Prop. Lin
avatories nC To Existing
Kitchen Sinks / Not Conn.
Dish Washers Sewer Boxes
Waste Disposals -
Wash Trays STORM DRAINAGE
Washing Machines J Size
".Vater Softeners.. Material
Bar Sinks To Ivfa"in Drain
'omb.knk x Trays To ,Curb
Dental Units tF-1'
Drinking Fountains
Flwr Drains WATER SYSTEM _
Hoppers- ' Size f '
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee .p.a
Area Drains Main Drain Fee _
Water Leaders Storm Drain Fee
'Sprinkler VLoves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE �D
RECORD OF INSPECTION
Underground Rougl . "
Partial Rough_
-Rough. Complete_
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