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W ® APL O 6 1t BUILDING PERMIT
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CUPFRTINO'FEs A96B
° J Sanitary No. 1:3 6153
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Uate_g�-.. Permit No._
° VI ' FRfc�
o Application is'hereby ma a or a permit to
a
V) story,Type s' `DDa Building
W I to be occupied only as xky 04
0 o in accordance with Plans, Specifications and Plot-Plan filed herewith.
3 Estimated Value of unprovements;$`,�f 0t70 '- Fee$__A QO
z J It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
J i all other laws applicable to the construction, location, and use.of buildings within the Cit of -
2 o Cupertino will be complied with. y
3 a J7/71— CR'4W'r
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w By err--t Address '' 1
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Approved f
State Licens �S/7 �`�"� HUI ING INSPECTOR
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I AGREE I WILL NOT VIOLATE ANY OF THE WORKMEN'S
COMPENSATION LAWS zTHE STATE OF CALIFORNIA. �
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FIXTURES l BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size ,/
Water Closets Materia!
Bath Tubs / To Curb
Showers J To Prop. Li e
Lavatories To Existing –
Kitchen Sinks / Not Conn.
Dash Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE,
Washing Machines / Size
Water Softeners Material _
Bar Sinks To Main Drain
Comb. Sink w Trays - To Curb
Dental Units
Drinking Fountains
Moor Drains WATER SYSTEM —
Hoppers Size
Restaurant Sinks Material
San Traps T TAL FEES
Urinals Fixture Fee .fop
Area Drains Main Drain Fee .p6
Water Leaders Storm Drain Fee.', '
Sprinkler V01Vcs Water Sys. Fee .�
Permit Fee "
TOTAL 11 TOTAL FEE
RECORD OF INSPECTION
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.Partial Rough..
.Rough Complete..
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Final...
State License 12422
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Remarks"'(Check ✓T
Type of Appliance Units Fees II New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters `
Blower Furnaces 6d
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables "
Gravity,Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
NAME TYPE)
/ aN
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HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Tested and Approved ............... ......
DATE
State, «tee
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Remarks`(' ed ✓)
Type of Appliance I Units Fees II New I Replace (,Relocate
Gas Ranges
\Vall Heaters
Gas Plates' I I: t
Circulating Heaters I I 1r
Blower Furnaces II I -!v0,
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
I II I
Miscellaneous
NAME TYPE ••
I I II I
Appliance Fees
Inspected and Approved .....1..`! ,..... ......
DATE IIINSPECTOR
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