51087 (2) 10766 Linda Vista Drive 24
LOT NO.
NO. Q ei ET
N �
® 1 L TION FOR GAS PERMIT
I.
OF CUPERTINO
W ¢ ISEP 14' 1965
fo
Y
¢ 4
Sept. 13 5
3 a Uarr p 196_ Permit No.
CITY gF . Cl1�ERTR^,XCupertino
Fer$ 1. 5�
W W
O A kation ,s ere mad to the Cit of Cu ertino for permit to install as pipes
PP Y Y P P 8' I P
'o 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
<w of Cupertino, and all other laws applicable thereto.
u x
Use of Premises Rc-Si ranee
00
> 0
3 Owner P.,-;ank1 i+._R@hl Cnpat. Address P 0 RnX Ql l Campbell
0a
�Z ByCentral Service Co. Inc. Address 451 Queens Lane, S.J.
J Q
CONTRACTOR, AGENT
a < Phone 298-0556
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a o �State Licensel71537 Approved WILLIAM D. QFNrvIr H
PLUMBING INSPECTOR
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Remarks (Check ✓)
Type of Appliance Units Fees New Replace Relocate
Gas Ranges
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 I . -2 I Size of Main
Gas Piping Fees I S.—c.1
Tested and Approved ._.._.....................:..._.................___._..._.._._.
DATE. INSPECTOR.