2605 //075 La Paloma Drive LOT No. %97
NO. Q S EE
® APPLICA IPFOR PLUMBING PERMIT
FEB 2 8 1964 CITY OF CUPERTINO
Date ,2 —�l�•.+r•RW!\! , 195_ Permit No. C �S
�s Iii -vP�sr �a�v�i
Fee $
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
g Cupertino, and all other laws applicable thereto.
d
L Use of Premises Residence
a'
v
Owner ward Crump Addresses Box 634 Cupertino
By Address itneB
CONTRA OR, AGENT
Phone Approved
PLOMHING INSPECT'
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size q-li ,00
Water Closets Material Gr-
Bath Tubs. l l ll To Curb ✓�
Showers To Prop. Line'
Lavatories 3 To E
Kitchen Sinks Conn
Dish Washers i
Waste Disposals l
Wash Trays STORM DRAINAGE
Washing Machines 11 Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Traysl To Curbl i•
Dental Units i
Drinking Fountains) ll
Floor Drains lWATER SYSTEM
I Hoppers l Size Z'/ l
Restaurant Sinks l Material 1/,00
Sand Traps l TO AL FEES
Urinals Fixture Fee /0/0 0
Area Drains Main Drain Feel 7,010
Water Leaders l l ll Storm Drain Fee l
Sprinkler Valves Water Sys. Fee
Permit Fee 2-100
TOTAL 1 10 l/0 11 TOTAL FEE /S 00
RECORD OF INSPECTTON
Partial Rough
Rough Complete —�
Final —/e �/ `