1129 GAS AND PLUMBING PERMITr
'D,rl QsI ' l N 9 ^ r� LOT NO.
�.rNO�r TIMET
M6 �N FOR GAS PERMIT
NUS!1 1960 LF OF
CUPERTINO
Da�Y OF CUPERTI(Vp 195_ Permit
No.
Fee $
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.
Use of Prergises 5- L—_
Units Fees II New
i_ -s I I II I I
aters I I II
Cates
CAuiating Heaters I I II
Blower Furnaces I I II I
Gas Fired Boilers
Steam
Furnace
NAME TYPE)
Iqspected and Approved ............... --- I---------------------- ------------------------
DATE INSPECTOR
HOUSE GAS PIPING
Numr of Outlets I I Size of Main
Gas ping Fees I S
Tested nd Approved ... 0 6.6.....I .. .... .........-------------
DATE INSPECTOR
'I; the undersigned do hereby certify that.
the ownerar. occupant of t single family dwelling a
� 3 '�21' O ( ) i Q far:�rni ch I am malting
application to do P, Oka work as a home owner.
Iso certify thp.t I will not hire any non -licensed
Pit-
U Q.or contractor, but will do this work myself.
x" 9-L S -V (3 Avkx A -e-/ !"
TaEPHO tiE NUMBER SIGNATURE
(�V I LOT NO._,
NO. §TREET
APP ATION FOR PLUMBING PERMIT(//5S
1 pOF CUPERTINO
D AcAn195— Permit No. '
_ pD-((jj Fee $
{l ti s Cn�li� ��f'He City of Cupertino for a permit to install plumbing
pip��1�n /or xtures listed on the reverse side hereof, and agrees to install said rices
and/or fixtures in accordance with the provisions the P bing Code of the Ci of
Cupertino, and all other laws applicable thereto.
Use of Premises
a
Owner
Byit�ik
CONTRACTOR, AGENT
Phone
Address
Addres�6`� 5'B
.d e/%
Approved
PL G INSPECTOR
UNITS I
FEES UNITS I FEES
Water Heater j
j Size
Wates Closets j
�j Material r j j
Bath Tubs j j
jj To Curb
Showers j I
jj To Prop. Line
Lavatories j j
jj To Existing j
Kitchen Sinks j j
jj Not Conn. j j
Dish Washers j j
jj SEWER BOXES
Waste Disposals
Wash Trays j j
jj STORM DRAINAGE
Washing Machines j j
jl Size
Water Softeners
Material
Bar Sinks
To Main Drain
Comb. Sink & Trays] j
ij To Curb
Dental Units
Drinking Fountains] j
Floor Drains I 1
II WATER SYSTEM
nt
Urinals
Fixture Fee
Area Drains
Main Drain
Water Leaders
Storm Drail
Sprinkler Vaives
j j jl Water Sys.
Permit Fee
TOTAL
TOTAL FE
RECORD OF INSPECTION
10
63,;z_5- I ' LOT
NO. - TREE
APPLICATION FOR PLUMBING
�,._....
+CITY
OF CUPERTINO
/�
PERMIT
� d
19AW, Permit No.
V� 4
�T nI
�I�6V t �cI i�(fi JX the City of Cupertino for a permit to install plumbing
pipes andlor fixtures listed on the reverse side hereof, and agrees to install said ices
and/or fixtures in accordance with the provision of tj�P� Cod ofthe Ci of
Cupertino, and all other laws applicable theret
Use of
Owner ,6�1 � d V44,
By,i�Q,AiY,�f.�/i�.�.,P�/•L
CO TRACTOR, AGENT
Phone Z� {
Address ®_�Q,1J3 6`
Address
Approve
11 INSPECTOR
I I UNITS I FEES II 1 UNITS I FEES
Water Heater
Water Close
Showers j
�j To Prop. Line j
Lavatories j
j jj To Existing j
Kitchen Sinks
j jj Not Conn.
Dish Washers j
j jj SEWER B XE$
Waste Disposals i j
jj j
Wash Trays j
j jj STORM DRAINAGE
Washing Machines j
j jl Size
Water Softeners j
j jj Material
Bar Sinks j
j jj To Main Drain
Comb. Sink & Trays j
j jj To Curb
Dental Units j
j jl j
Drinking Fountains] j
II 14-0
Floor Drains j j
WATER SYSTEM
Hoppers j j
jj Size j
restaurant Jinks I 1 II Material I I
Urinals j j j1 Fixture Fee j
Area Drains j j jj Main Drain Fee j0
Water Leaders I I II Storm Drain Fee I
Sprinkler Valves Water Sys. Fee j
Permit Fee
RECORD OF INSPECTION