1762 (2) �20/z9 C s 0"'Z' s. (-0, mo_
LOT NO. 36
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® C'A OR BUILDING PER IT \ ts�
' `ion 18 1962. FICUPERTINO (_g 4l
Date j"" RfL Permit No. Z
SI YFY>;J.a permit to eK a--r
a story,Type S �' T Building
c� at SOretscT �'� 60! "
to be occupied only as -Y,^«<F
in accordance with Plans, Specifications and Plot-Plan filed herewith;
/S 000_
Estimated Value of Improvements,$ do_i Fee$ T�
's.
s hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and•
all other laws applicable to the construction, location, and-use of buildings within the City of
Cupertino will be complied with. "..
1 OwnerPiT2 - CT.4;vE _ Address -S-S4- /! FipsrST. S,-T,
By � 9K c - Address t t
�-i'�ONPMCMB�.AGENT
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"Phone �� 7-•�1 APProved X
1 - `ButLDING INSPE40
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FIXTURES___ NUMBER MAIN DRAIN
I UNITS I FEES UNITS FEES
Water Heiuc, 1 Size
•water Closets ,Z �� Material r /
Bath Tubs To Curb
Showers To Prop. Line
Lavatories r2. �� To E�' 2 _
Kitchen Sinks �� N Con .fl
Dish Washers / 11 SEWER aOXfiil
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material I
Bar Sinks To Main Drain
Comb. Sink-&Trays To
Dental Units w
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers
Restaurant Sinks Material
Sand Traps T TAL FEES
Urinals Fixture Fee ; I //. 6-0
Area Drains Main Drain Fee -- ,
Water Leaders Storm Drain Fee
Sp "nkl r Varves II Water Sys. Fee I /.O O
Permit Fee /.6w
TOTAL TOTAL FEE
RE OR OF INSCTION
Partial Rough•
Rough Comp l to -
Final
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Remarks (Check',b)
Type of Appliance Units Fees II New Replace I Relocate
Gas Ranges I I I I
Wall`Heaters
Gas Plates
Circylating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables I 3
Gravity Furnaces I I 11 1 S I
Suspended Unit 1
Floor Furnace 1 1 1
I I II I
Miscellaneous i� I i
NAME TYPE) I
I I II I I `
I i II I I
I I II I I
I I II I I
pp lance Fees 1 1 -11 1 1
r s�
Inspected and Approved ..............:_.1................_........................�...
DATF. .INSPECTOR
HOUSE GAS PIPING
Numbec of Outlets I , I Size of Main I �'
Gis Piping Fees 1 /.od 1
Tested and Approved ..� I .L.1.... . ..........:............ .,......
DATE 'INSPECTOR
--titer. a
ate License/697X�
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Remarks (Check 7)
Type of Appliance (Units Fees II New I Replace Relocate
Gas:Ranges
Wall Heaters h��4
Gas' Plates
Circulating Heaters
Blower Furnaces / /. ✓
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables ��
avity Furnaces
Suspended Unit
Floor Furnace 11
NEWMiscellaneous
NAME TYPE
pp lane Fees //�
Inspected and Apprdved7/ .02..x._... . - ...................._....I
DATE INSPECTOR
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