515 (2) LOT NO.
,;. APP TEPN i QR APPLIANCE PERMIT
" C
1�7( OF CUPERTINO
''• Date X96....: Permit No.
-
: :;: .; I Y of wKgTlNO Fee a .�. 50
-"App ication Is hereby ma e to the Cif C
ty oupertino for a permit to install
?' cG: s a Lances as listed on the reverse side hereof• and agrees-to install said
,rt.:,;� � 8a PP.�
�« appliances in accordance with the provisions of the Plumbing f7ode of the City
H of.-Cupertino, and all other laws applicable thereto.
v" '_•'03��BP_CB
.. Use of Premises i
Address IP :L _
Address
130 ,S Gi7mt n LjCOtJTRACTOR,LAGBNT�4
�h hill coli eT a Approved
-• G^ - PLUMBING INSPECTOR
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Remarks (Check d) "
Type-of Appliance IUriit Fees II New. Replace I Relocate
Gas Ranges
\ all Heaters
Gas Plates
Circulating Heaters
Blower Furnaces 11 II I I
Gas Fired Boilers I
Warming.Ovens I I I
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit' I I II I —
Floor Furnace
I I II I
Miscellaneous
(NAME TYPE)
I I II_ I
I i II I
I II I ti ri
71nPP
lance eF es �spected and Approved .L:�_�G/... . .. .........:....:....a.......
DATE INSPECTOR '
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e,License c?6'A2`1.385
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Remarks (Chedc J)
Type of Appliance _-.I;Units •Fees II New I Replace I Relocate
Gas Ranges .
Wall Heaters'
Gas PlatesCirculating Heaters •I=�•r� '• � II I -
Blower Furnaces
Gas,;Fired Boilers I -'I:' ' II I '
Warming Ovens
Percolators ,q I I •
Griddles lO `
Steam Tables
Gravity Furnaces I Ist I
Suspended Unit
Floor Furnace
Miscellaneous
NAME TYPE)
.•, I I •�.-II I I
I I • . 'II I I
pp lance Fees
Inspected andiA'pproved .......'.:1 alk. .........:..... ..............
HOUSE GAS PIPING. .• s;
Nu '+zr of Outlets I„'�L ;I, :Size�of Ma.n
Gas pipingFeel
Tested';;tnd Approved "
SP
' , D Te. I :`•`r 'f [NECTOR
GAS SERVICE NOTICE 1 OPYE
BUILDING INSPECTOR'S OFFICE
CITY„'OF CUPERTINO
�� �...... .
To . I96
-You are hereby authorized to-connect the GAS service for, -;
Owner or Tenant
.. .. .. - .. .. . .......... ...
., yr
New Service
No:,ofiMeters ---
r.•..,-... Reconnect
-,y.: ,•-. Move Service
No. of Add. Meters .............. Move Meter -------- .-----.._
PLUMBING INSPECTOR
a: q�tt0 1/60-500
_e=