51141 4?w LOT NO. ,
NO. STItEEt'
r
IOATION FOR PLUMBING PERMIT
Z a OP CUPF.RTINO
Zi
r o tj Sanitary \'o.
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o a Date , � �966 Permit No
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W 4 A'�t 0 I'ce S��—
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p h an rs 1 (�/�e City of Cupertino for a permit to install plumbing
o < pipes and/or fixtures h9ted �'t9k{reverse side hereof, and agrees to install said prices
i m and/or fixtures in accordancewith the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws .1 plicable hereto.
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� n Use of Premises�t/ `
0 O � e �/�(�� C./l�i�'/,t"[_'H D/ a"IS� Address2eo 7�S�� / `/'"`'•
O <, —V LY.�C9 y! 1'1L�i• Address!/�7G�ditLU/Y�.fI6
3 0 C NTRA(�.i/'OpR, AG NT Os G�YD S
— w . Phone `�0y�i�
State License/ vy 2 y` Approved
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U PLUMBING INSPECTOR y
FIXTURES
UNITS FEES UNITS FEES
Water Heate I I Size
Water Closets Material LZ
Hath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Har Sinks To Main Drain
Com . Sink-xTrays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER Y TEM
Hoppers Size
17X 1 -71
Restaurant Sinks Material
San Traps TOTAL FEES
UrinalsFixture Fee / - /0.00
Area Drains Main Drain Fee '0 O
eater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee r O
Permit Feed �J
T TAL TOTAL FEE _
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final
-/ o o�JY/ oll,-Al&C,P- 4dLOT NO.
VVV"`-'^^`� NO. STREET
PPLICATION FOR GAS PERMIT
i CITY OF CUPLRTINO
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Permit No.
3 LL
° App cats /I eby made to the City of Cupertino for a permit to install gas pipes
°o and/or gasapplhd�s }}bled on the reverse side hereof, and agrees to install said pipes
i m and/or appliances a e with the provisions of the Plumbing Code of the City
w of Cupertino, and all ner law 5 applicable thereto.
LL U of Premises
Cyr�
00 1
3 w er rjs r� Address ��75����%y ��d
o Address l T70�
3 ONTRACTOR, AGENT
— m Phone 6/' 30 /0
ao State License �86�v6 Approved
- 0 PLUMBING INSPECTOR
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 - j Size of Main
Gas Piping Fees V-501
Tested and Approved _................ .........................------........_............
DATE. INSPECTOR