2604 La Paloma Dr v LOT NO.
? APPLICAT
IO'N FOR PLUMBING PERMIT
FEB 281964 CITY OF CUPERTINO
DaIT�M�-0IDCDT'�+t' 195_ Permit No. �v 0
� JTZTT� c�c a'I
Fee $ �70�
Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
?� Cupertino, and all other laws applicable thereto.
°v Use of Premises Residence
v
Owner- ward Crump Addresspo Box 634
Cupertino
By Crowley Co Address 855 Jackson Mtn View
ONTRA^ '
Approved
Q, PLUMBING INSPECTOR
--,3
FIXTURES NUMBER MAIN !DR IN
UNITS FEES IUNIT
SIj
FFEES
'0
W r r Heater I Size
Water Closets Material
Bath Tubs To Cu
rb
Showers To Prop. Line
Lavatories j ¢ j 11 To Exastanpj
.Kitchen Sinks j^ j jj N t Con
Dish Washers
Waste Disposals j j jj j j
Wash Trays j j STORM DRAINAGE
Washing Machines j�j Size j
Water Softeners Material j
Bar Sinks To Main Drain
Comb. Sink &Trays j Jj To Curb
Dental Units j j 11
Drinking Fountains j ISI j
Floor Drains j j WATER SYSTEM
Hoppers j j jL Size �r/ �_ /.0
Restaurant Sinks j jj Material Cor
Sand Traps TOTAL FEES
Ljrinals j
IFFixture Fee
Area Drains j j 11 Main Drain Fee 2,
Water Leaders I I Storm Drain Fee
Sprinkler Valves j j Ij Water Sys. Fee I �0
Permit Fee 2.o
TOTAL Iy 1,.4 TOTAL FEE 170
RECORD OF INSPECTION
Partial Rough 2
Rough Complete S
Final