2534 . . ^'A? Q ZtkiOR
NO. STREETS.raR'!�JUL
APPLICA. 1iBUILDING PERMIT
° IJTYIOF QUPERTINO /l
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Date— 2 . 19 et ` '196=.3 PermrttarY No.No.
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`o � Applications;;'herebyfmade�fpr.apermitto E/IEC�
a N a�story,Type s ✓ /' T Building
to be occupied only as dl"K lr Ami ✓ d /yt2tYA/G
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00 in accordance with Plans, Specifications and Plot-Plan filed herewith. ,
Estimated Value of Improvements, $ 95 000Fee$ r. 00
i J 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 the Cit of
o Cupertino will be complied with. y
Owner Address 5S%
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a0Phon 53-3/ 03 _
Approved
State License /57' �� R DINo
INSPECTOR
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� �& NOT \'/ ANY ;THE WORKMEN'S OF CALIFORNIA.
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FIXTURIiS NUtiIBLR MAIN DRAIN
UNITS FEES UNITS FEES
WV n,r Heater Size _
Water Closets Z Materia' '
Bath Tubs To Curb
Showers / " To';Prop. Line
Lavatories Z To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals y,
Wash Trays STORM DRAINAGE
Washing Machines / Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Deetal Units
Drinking Fountains
Floor Drains WATER SYSTEM .
Hoppers Size -I
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee - gF
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Voives Water Sys. Fee f
Permit Fee yM
TOTAL TOTAL'FEE /Jr& ,,-
REC D OF I PE TION
Underground Rough._ 1
.Partial Rough-. _ ..�.
.Rough. Complete..
Slain Drain i
Final... -�
I AGREE I WILL NOT VIOLATE ANY OF THE WORKMEN'S
COMPENSATION LAWS OF THE STATE OF CALIFORNIA.
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`":I(Wihrks;i Check
Type of Appliance Units Fees] _ew'L•.;Replace I Relocate
Gas Ranges
Wall Heaters ': -e '+ `
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
Number of Outlets Size of Maine
Gas Piping Fees it "'
Tested and Approved .........
DATE INSPECTOR
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'Remarks.(Check-✓)
Type of Appliance I Units Fees II New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired BoilersI r
Warming Ovens P
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
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. (NAME TYPE) II
—Appliance Fees ��—
Inspected and Approved %0 31. ..'�... . .. .........................
DA F. INSPECTOR
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