1567 /opRR LOT NO. 30
N�1APL'1 1r10N FOR APPLIANCE PERMIT
U OF CUPERTINO
19 1963 �
Date Nov. 12 1963.._ Permit No. _
CITY OF CUPEt
t Fee Z /6•75
Application is hereby made to the City of Cupertino for a permit to install
gas appliances as listed on the reverse side hereof, and agrees to install said
-4 appliances in accordance with the provisions of the Plumbing r'.ode of the City
Cq of Cupertino, and all other laws applicable thereto.
c
Use of Premises
tiOwner Les Tom Enterprises Address 1817 Hamilton Ave.,S.J.
BYR Address Q61 Camdpn Avebel
n 378—GAcroa, AGENT
Phone_ Approve
PLUMBING INSPECTOI
Remarks (Check ✓)
Type of Appliance I Units Fees II NewI ReplaceI Relocate
Gas Ranges I I I
wall Heaters 131 0 x I I
Gas Plates
-#..eaters I
Blower Furnaces 1 .0011 x I
Gas Fired Boilers 1 11
Warming Ovens I I I
Percolators 1 I I
Griddles 1 I I
3 .,Tal�les 1 I I I
Gravity Furnaces I_ I
uspended Unit
Floor Furnace
'.Miscellaneous 1 I it
(NAME TYPE) 1 1 II
;Heat Duct 111 I 2.75_ I
I
-� I -1 0011 -
I II I -
pp lance 1 ces
Inspected and Approved .1./ .b. ..b :. ...........................
O F INSPECTOR