2374 V �Vl9y� I l W\C�L`K90 �uik-, _ 'LOT NO.
PS ET
PMI ATION FORPLUMBING PERMIT
T0�11
CITY •OP CUPERTINO
21 163 �.AUG //}} sanitary No.
o Date�d �, 196 3 Permit No l
a
aCITY OF CUNER71y!�1 Pee
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
'z N 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. -
j Use of Premises
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3 Owner /n1XlI/ItfS l'»(!(/(P Address�md�!C�p
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' o ByTNec'roR,cs Address
3 <
— m Phone
ao State Licensea -Approvedt�t-�`�' •' /Gttiyt,LtG•�
SCJ PLUMBING�IRSPEitTG¢R
c/ I t
FIXTURES NUXIBER MAIN DRAIN
UNITS FEES FUNITS FEES
Wa;er Heater Size F
Water Closets Matera! G,I,
Hath Tubs To Curb
iltpwers To Prop. Line
Lavatories To Existing
titchen Sinks Not Conn.
Dish Washers I I Sewer Boxes
Waste Disposals
tVash Trays STORM DRAINAGE
Washing Machines Size
TVa[er—Softeners Material
Har Sinks " To Main Drain
Comb. Sink & Trays To Curb
Dental Units_
Drinking Fountains
Floor 'Drains WATER SYSTEM
Hoppers Size "
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee 90
Arca Drains Main Drain Fee atw
(Water Leaders Storm Drain Fee
Sprinkler Vaivcs Water Sys. Fee /•00
Permit Fee -
TOTAL TOTAL FEE IiI.Vo
RECORD OF INSPECTION
Underground Rough...
.Partial Rough..
Rough . Complete..
Main Drain
Final...
3
Bldg. Dept
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
❑ Sewe Connection v�.�-LJ
Sanitary Permit No. ......_...........
Plumbing Final ` Plu ing Permit No37.q... ---- -- -
- e----...............
Lot No�. -0 ----1:.... ...
Owner or Tenant .......... t
At .............�.. .... ......--._.
G.
Tract ...-------- ----.....� @h;Ci..d(------
...... ......... ..............
Date Connected ,
Date Final � �'•� - -
............ =- ,,lti,r:,i, ----
PLUMBING INSP CTO
Ill 7/63-1M
OFFICE
(� COPY
GAS SERVICE NOTICE
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
".� 7
To 1.
You are hereby authorized to nne t the G S ervic r
Owner or T ant .-------------- .... .--- -- _...---
At ........... p
New Service ..:. ............ ........
No. of Meters ....._-I......-.......... Reconnect
- Move Service
No. of Add. Meters ----------- v Meter...... ---
s
PLUMBING IN E O
110 7/61-5oo