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91'EP 1 Ail I��FOR B 1LDING PERMIT
° aUN 2 96 ;^ OF CUP, TINO'
6 f Sanitary No. ` ? '33
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= a Uate 196 3 Permit No.�
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F3 Estimated Value of,Improvements, x L10. 0 Fee$_ �• Q �'�--.
i J It is hereby agreed that the requilements of the Cupertino Building and Zoning Ordinances and
* z all other laws applicable to the construction, location, and •use•of buildings within the City of
j 0 Cupertino will be co m lied with.
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StaW,Licens �r�7 / �' BUILDING INSPECTOR
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Remarks (Check';✓I)
Type of Appliance Units Fees New,, I Replace_11IRelotite
Gas Ranges
Wall Heaters
Gas Plates II i I
Circulating Heaters I I II I I
Blower Furnaces
Gas Fired Boilers
Warming Ovens I II I
Percolators
Griddles
Steam Tables
Gravity Furnaces I I _
Suspended Unit I II I
Floor Furnace I
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Miscellaneous I I ii
(NAME TYPE I II
I I II
pp lance Fees i t- J �r
Inspected and Approved
DATr. INSPECTOR
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FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Vater Heater / /.UU Size
Water Closets ,i,O O Material G 9-0O
3ath Tubs J 00 To Curb a r;:
ihowers J .p 0 To Prop.;Sine
Lavatories O To Existing—
{itchen Sinks / /,Op Not Conn.
Dish Washers 11 Sewer Boxes
Waste Disposals I ,-
Wash Trays STORM DRAINAGE-
Washing Machines Machines 160 Size
Water Softeners Material
Liar Sinks To Main Drain
-omb. Sink c Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size "
Restaurant Sinks Material .00
Fan Traps TOTAL FEES
Urinals Fixture Fee I / ti
rhea Drains Main Drain Fee ivy
Water Leaders Storm Drain Fee
sprinkler Vaives Water Sys. Fee
Permit Fee
TOTAL IlleVil TOTAL FEE 16
RECORD F I PE ON
Underground Rough._
Partial Rough..
Rough. Complete.. Z
Main Drain
Final...
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I AGREE I WILL NOT VIOLATE ANY OF THE WORKMEN'S
,i COMPENSATION LAWS OF THE STATE.OF CALIFORNIA.
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Remarks (Check J)
Type of Appliance Units Fees II New I Replace I Relocate
Gas es Rang
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
,(NAME TYPE,
HOUSE GAS PIPING
Number of Outlets Size of Main ,3
Gas Piping Fees
Tested and Approved ....f..q.'3.�.r�.... .. . ...:.........
DATE INSPECTOR
State License ,as
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