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Date 9+2 Permit No. _ _ -)
i on isherebymade F '�pj{mit to
a QBrl', IYT Building
at Sa.-,rE.cscr sJr3414 - I-A-r O.Voss "Y .
to be occupied only as
in accordance with Plans, Specifications and Plot-Plan filed herewith.
y.
Estimated Value of Improvements,$ O oo, as Fee$
�._; It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances-andl';
W, ,all other laws applicable to the construction, location, and use,of buildings within the`City of':
Cupertino will be complied with. :•'s•
Owner�'�<Tt" C/Iff<vE"; AddressjBULLMell
�SS�a <BAddresY
CONTRACTOR AGENTPhoneV -7^ YSy5� ApproveINSPECT
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FIXTLJRES NUMBER MAIN DRAIN
I UNITS I FEES 11 IUNITSI FEES
Water Heater I II Size / I/."
Water Closets y •54II Material e I I .I,'..
Bath Tubs I 'SII To Curb ••;'.I
Showers I / I ,:.SII To Prop. Lino/
Lavatories m1IILTo Existing /
Kitchen Sinks �xAII&Not Con ),AO
Dish Washers I / AIDEwER BOXES
Waste Disposals / klim I
Wash Trays IIIw STORM DRAINAGE
Washing Machines I EII1Size I I
Water Softeners I I 11I1iMaterial I
Bar Sinks - II IISTo Main Drain I
Comb. Sink &Teqs I IIJ'To
Dental Units
Drinking Fountains) II
Floor Drains WATER SYSTEM
77-1
Hoppers Size /
Restaurant Sinks Material
Sand Traps I I II TOTAL FEES
Urinals I I Fixture Fee
Area Drains Main Drain Fee g_ys
Water Leaders I I Storm Drain Fee
Sprinkler Vaives I I I Water Sys. Fee I /•p-p
Permit Fee /.s0
TOTAL L/ TOTAL FEE /g• vS
RE -OR O CTION
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Remarks (Check ✓)
Type of Appliance I Units Fees II New I Replace I Relocate
Gas,Ranges "1=Y'I. - C�r;,S�''• .
Wall Heaters ",9 :.�� �., r1,p` L.i "ry
Gas,Plates •:m "`��.`.:{ ' ii�fi.
Circulating Heaters
Blower Furnaces
Gas Fired Boilers :/-I I , y
Warming Ovens
Percolators �� '•(i .�;,� ti
Griddles
r3 Steam Tables ?
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
NAME TYPE)
p�Fees ^r
Inspected and Approvedy------..__..:.:.!_.........._..............__......:.........
DATF. INSPECTOR'
HOUSE GAS PIPING (�
Number of Outlets I -P/I Size of Main
Gas Piping Fees v
Tested and Approved . ... .p-/...L-. . �........ ........ ....
DATE INsP&TOR
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Remarks (Check J)
Type of Appliance I Units Fees II New Replace•I Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers �� t
Warming Ovens
Percolators
Griddles
Steam*Tables
Gravity Furnaces I _
Suspended Unit I II _�_ I�
Floor Furnace I� I
I _
Miscellaneous
(NAME TYPE) I I II
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App lance Fees inspected and Approved/Q . .L... ... ...................... .:........
DATP. INSPECTOR
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