1155 /No.-
NO. STREET
ON FOR GAS PERMIT
® l_ OF CUPERTINO
NOV 16 ' IBJ LQ
Date 195_ Permit No.
CITY OF CUPERTINO Fees i �=
Application is hereby made to the City of Cupertino fora permit to install gas pipes
and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and allther laws applicable ereto.
c
Use of Premise �a zD
,-X Owner �—y �� Address_
BY (n TRAddress 1
CONTRACTOR, AGENT
Phone3,9 �/ . APpro led t—
PLUMBING INSPR OR
o-
--------
b ---- --- -- —
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m
m a ! I n
I, the undersignbd do hereby certify that I am
the owner an occupant of the single family duelling at
e , for which I am making
application to do "ork as a home oYmer.
I also certify that I brill not ? re any non-licensed
9LxL
,-&— or contractor, but vd1l do this I.Tor.< myself.
16 -2 97 ,54r
SIGn�pTUR�
GAS SERVICE NOTICE OFFICE
COPY
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
1-17-
............................. ...............9................... 1961
TO
You are hereby authto connect tji�GAS service for
Owner or T( ZZ i 1! - --%----
At-... ........... ....... ..��--Qa
New Service --------L
No. of Meters .....
.... .. ... Reconnect .....-.......................
Move Service ------------------------
No. of Add. Meters .............. ov eter ........... --------------
------- .......j - -----------
............. -
PL INSPECTO
110 1/60-500
em i
NOTICE TO CUSTOMER
Location:.-V ..............
City- .___._-.�_..__._.--.--_..of Day....-----
While this Company dose not assume and is not cbargenble with any responsibility for the
condition of your equipment, in representative while on your premises today did observe the
following condition affecting the utilization of (circle which) gas, electricity, steam, water,
served by this Company,namely:
This condition is considered (check which):
I hereby acknowledge receipt
OV
...IMPROPER OPERATION. It should be corrected or of the forego: Notice this
r epaired es soon as possible.
UNSAFE AND IMMINENTLY HAZARDOUS. The
following was done:
`..-.-.[__....---..............................f
...-.Equipment disconnected. (Customer's signature)
Service shut off at the meter,or of turned on.
-------- turned off or a temporary safeguard PACIFIC GAS AND
provided,pending final correction.If this condition ELECTRIC COMPANY
is not corrected within the next few days, equip-
ment will be disconnected or service shut off.
Original for Customer.Duplicate for Company $y., !! '�'li- r
Attach to work or service tag. / ( ts upresentative)