2756 110$4 I LaPalona Dr.
LOT NO.
NO. TR
ff
iAOR PLUMBING PERMIT
OF CUPLRTINO
ro JUN 161964 ' sanitary Nn.
3 a Date 196— Permit No
W_
CITY OF CUPERTINO Fee $ 'M
0
° Application is hereby made to the City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
w x
� ,. Use of Premises Residence
00
> WA. Saarne 11084 LaPaloma Dr.
3 Owner Address
Jz COAST WATER SOFTENER CO. THE \ EDA
z By Address
CONTRACTOR,AGENT I I �
3 295 3435
W W Phone // ,9 77 ���jj�� zz
< o Sate License . _Approved 1't , V L' /
PLUMBING INSPECTOR
FIXTURES NUN BER ij MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closets Materia:
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
{itchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners jTo
erial _
Bar Sinks Main Drain
Comb. Sink s Trays Curb
Dental Units
Drinking Fountains '
Floor Drains WATER SYSTEMI
Hoppers. Size
Rest6urant Sinks - Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Vmvcs Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
.Partial Rough..
.Rough. Complete..
Main Drain
Final...