2535 �O/H I MA
LOT NO.
NO. STREET _
�AP.PLICAION BUILDING PERMIT
I CITY OF QUPERTINO .,
3 LL Date '• JUL 2 'y 196-3 Permit No. e,2 Ji— 3
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Application is hereby made.for•a permit to EtPEC�
C1yrLur LurGni.Iyt i�
ato a story,Types Building
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J `o in accordance with-Plaits, Specifications and Plot,Plan.filed`herewith.
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3 Estimated Value of.lmp'royeplei;t;$ �i�'. 000 Fee$ 6
i J It is hereby agreed`that'the rdq'uirements of the Cupertino Building and Zoning Ordinances and
J Z all other laws applicable. to the--'construction, location, and use of buildings within the City of
j O Cupertino will be complied with. +• �;
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AGREE I WILL NOT VIOLATE ANY OF THE WORKMEN'S
COMPENSATION LAWS OF THE STATE OF CALIFORNIA.
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FIXTURES NUT% BER MAIN DRAIN
FUNITS FEES UNITS FEES
Water Heater Size rl
Watei Closets Materia!Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers I Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
'.Washing Machines Size
I'rf/ater Softeners Material
Tar'Sinks To Main Drain -
C2mb. .Sink s Trays To Curb
D;nt.tl Units
Drinking Fountains
Irloor Drains WATER SYSTEM I
Hoppers Size
Restaurant Sinks Material —'
San Traps TOTAL FEES
Urinals Fixture Fee J
Area Drains Main Drain Fee •j,,,
Water Leaders Storm Drain Fee
Jpri kicr Valv,S Water Sys. Fee .(-
Permit Fee Zi
TOTAL TOTAL FEE jX0 I.
RECORD OF INSPFCtION
Underground Rough Qe�•—'-
.Partial Rough.- ' '. "'-'�'•
Rough Complete.. — �t`•�.
.Hain Drain
Final... i
�;-A6REE I WILL INOT VIOLATE ANY OF THE WORKMEN'S
COMPENSATION LAWS OF THE STATE OF CALIFORNIA.
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Remarks (Check J)
Type of Appliance Units Fees II 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
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Miscellaneous
(NAME TYPE)
HOUSE GAS PIPING -"
Number of Outlets Size of ain r/
Gas Piping Fees yS:�
Tested and Approved ... -
DATE <+L)-,V,1NSPtECT00.
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Remarks (Check ✓)
Type of Appliance I Units Fees II New Replace Relocate
Gas Ranges ,
Wall Heaters ,
Gas Plates I: I 'III
Circulating Heaters I ,: I II I I
Blower Furnaces ',w.I A Lqcj II I +
Gas Fired BoilersI 1A.1- II
Warming Ovens I Ui II
Percolators aI II
Griddles .
Steam Tables
Gravity Furnaces I -!IRA I_ I
Suspended Unit JA II _ I
Floor Furnace I :BIW II
1 _ I LIM II I
Miscellaneous I vim it
NAME TYPE) I Bin II
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Appliance Fees
Inspected and A roved.F^, __..........._..... ...
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TF. J INSPECTOR
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