2531 f t r rte,
0 a NO. //����STREIET LOT NO.
w C��A'PPLICA�T O FOR BUILDING PERMIT
3 ° l Cl -OF CUPERTINO"
' JUL 24 1963 Cu Sanitary No. 3�0
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w Date �� ]963 Permit No.__
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a . Cl pplirAtion is hereby made fora permit to E/lEC9
° a
a a a story,Type �- / � T Building
to be occupied only as
0 o in accordance with Plans, Specifications and P1ot,Plan fled herewith.
3 Estimated Value of improvements, $ 520a 06Fee$ 6-3 ' o
OJ 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
3 m Owner qkt- n4n'- Address 557 r
E Q a By Address
t a 0 Phon_ S3— 3/03 - A roved
State License ��/7�1� PP .
r - BUILDING INSPECTOR
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FIXTURES NUMBER MAIN DRAIN_,>
UNITS FEES II UNITS FEES
Water Hcater Size
Water Closets Material L
Bath Tubs / To Curb
Showers To Prop. Line
Lavatories Z To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
(Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain •, ;i-
Comb. Sink c Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER S STEM
'Hoppers Size
Restaurant Sinks Materia
Sand Traps TOTAL FEES
Urinals . Fixture Fee
Arca Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee /
Permit Fee
TOTAL TOTAL FEE Rrt
RECORD OF INSPECTION
'underground Rough...
.Partial Rough.. ' -3
,Rough. Complete. - �-
Main Drain �.-
Final._
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' AQREE I WILL NOT VIOLATE ANY OF THE WORKMEN'S
COMPENSATION LAWS OF THE STATE OF CALIFORNIA.
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,Remarks (Check V
Type of Appliance Units Fees'..... ......
I Replace,.Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired—Boilers
Warming Ovens
Percolators
Griddles I
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
(NAME TYPE)
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HOUSE GAS PIPING
Number of Outlets—j SizqOf 5 in
Gas Piping Fees
Tested and Approved ...........
DATE INSPECTOR
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State License
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Remarks"Check,v.
Type of Appliance I Units Fees II 'New ( RepC.e'JolR;e ocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters I h
Blower Furnaces
Gas Fired Boilers I F d
Warming Ovens
Percolators �)
Griddles3I
Steam Tables
Gravity Furnaces
Suspended Unit II
Floor Furnace
-Miscellaneous
NAME TYPE)
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64911
App lance Fees I ro, _
Inspected and Approvedl-C...
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DATE INSPECTOR
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