1071 (2) LOT NO.IV
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AUG 12 114 TION FOR GAS PERMIT
CITY OF CUPERTINO
&IJ_Y OFAIMO 195_ Permit No. 1—d 71
- Fee$ /sd
.� Application is hereby made to the City of Cupertino for a 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 all other laws applicable thereto.
` R
�Use of Premises— I FAMI1Y RESIDENCE
4Owner Address ���� /tL
By )OE AMARAL P1 ''A At Mr Address
. . 0019TRIftWALAMMA
Phone • SANTA CLARA, CALIFORNIA Approved
PLUMBING INSPECTOR
Remarks (Check -7)
Type•of Appliance I Units Fees I New I Replace Relocate
GasrRanges
Wall`s leaters
_ I I II I I
Gas Plates 1 I II I I
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles I - ' d .sl,:,•.•..
Steam Tables I I I.,,t'•at
Gravity Furnaces I_ I
Suspended Unit I II
Floor Furnace
I I II I
Miscellaneous
NAME TYPE) I I I
I I I II I I
I I II I I
I I II I I
I I II I' I
pp lance Fees I I I P
Inspected and Approved .......... ...:..-I.............. .............
DATE. INSPECTOR
HOUSE GAS PIPING
Number of v- I
ize of MainGas Piping Fees I /a ,Tested and Approed .�1 ..T/�OI.... ... . ...........................
DATR INSPECTOR
GAS SERVICE Norr1cE
O,
fr .. ... ��} *.OPY
1 1 BUILDING INSPEOTOR'S"jO�''PICii
fr„
JITO CITY OP CUPE.RTIN } ,�...an --: " - ....--..... 196.. .
You are hereby'auth " e o connect the G rvice for
d
Owner or Tenant . . . ............
At ......f -3... ... ....
C1.; �.. . . . ........
New Service ..........................
No. of Meters ................. Reconnect ...... .......................
Move Service ........................
No. of Add. Meters -------------- Move,Meter
...... ......-..---..--::..
UMBING INSPECTOR
110 1/60-300
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