690 oZdVI c LOT NO. #11
No. STREET -� Idlewild #288C
P OR APPLIANCE PERMIT
® OF CUPERTINO r^Q
Dat -IF 2/5y' 196_..._ Permit No.
CjjY O� CUPERTINO Fre s i s=
ppGcation is hereby made to the City of Cupertino for a permit to install
gas appliances as listed on the reverse side hereof, and agrees to install said
appliances in accordance with the provisions of the Plumbing rode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises
Res .
Owner Rousseau Org. _ Address 58 Ila a St.
-SAN (WLOS SHEET METAL WORKS, INC Addrew Fr soo
779 OLD Ce&WUcRQAA%EN
�Uf—p(tdthk CARLOS CALIFORNIA
Approv
PLVYBING INSPECTO
Akt
i
IIRemlrksPCheck �l`°'
Type of Appliance Units Fees �-Ne—w— RRee-lace I Relocate
Gas Ranges �I
�
-Ga;-Plates'Heaters �� __i
Circulating Heaters
Blower Furnaces I �� X
Gas Fired Boilers
"Ovens
Percolators,&,ge,
Griddles
Steam Tables
Gravity Furnaces l�
S
uspendedW,nit IIT
FloeF.Lurnace � � ��
Miscellaneous
(NAME TYPE)
pp lance Fees —��a�—�-
Inspected and Approved .................. ...............................................
DATP. INSPECTOR