1082 <� r(. . LOT NO. /3 C/
'I&E EE I. ...
AUG 12 19IV C�P ATION FOR GAS PERMIT
CITY OF CUPERTINO
CDTY D1�UEj�D 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.
v
Use of Premises
a I - FAMILY RESIDENCE
Owner Address
gyJOEAMARAL PLUMBING; Address
aaReaT+tl4ogF��AA
Phone SANTA CLAM-SALIFORNIA Approved > � .CiL_.Gm�
_ GPLI/MEING INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units Fees II New 'Replace Relocate
Gas Ranges I I
Wall Heaters I I
Gas Plates --
Circulating Heaters I
Blower FurnacesI-
Gas Fired Boilers I.
Warming Ovens I
Percolators
Griddles' :e-
Steam Tables -'• '_ ;:
Gravity Furnaces I 1 11
Suspended Unit
Floor Furnace I I
I I
Miscellaneous
NAME TYPE) 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
Inspected and Approved ..... .. .....:._L............_........ ........................
DATE. INSPECTOR
HOUSE GAS PIPING
Number of Outlets I '/ I Size of Main
Gas Piping Fees
Tested and Approved .. �. _ .. ..... - .......-
9A E INSPECTOR
GAS SERVICE NOTICE ,°£oPYE
' BUILDING INSPECTOR'S OFFICE..
CITY OF CUPERTINO
ry
. ........................ ...! 196.' . .
To
You are hereby auth9riAzed to connect the GA service for "
Owner or Tenant --- �.
.�. .--- ---. L _/
At---/0.34?.. .... - -------
�:o-,..
New Service krsst. ,..
No. of Meters ..-- ......:.......... Reconnect ..........................
- ^;
Move Service i
No. of Add. Meters -------------- Move Meter .......................... .
........ !k!Q . 'W:,--------------
P
------- --PI4iBING INSPECTOR
110 1/60-500 '