1820 (2) 171g1� ICl'I�� '`4?.il VIIvILOT NO.
NO. STREET
IN FR O'LIINiBING' PERMIT
CITY OF PERTINO CZg'7 )
OCT 10 1962 /
Date /n - 7— l4z Permit No.
CITY OF CUPERTINO 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
Cupertino,_and all other laws applicable thereto.
Use of Premises s X0 es
a
v _
� Owner tO JH c����( Address
gy Address ,
CONTRACIO , AGENT
Phone.&, �Z /_ J i Approve T
d v, M1_t� br s I 7 {� ' a (- Fk;: - - -PLUMBINGINSPE TO
�'7gCT"A' ,.i.rtr .bp...) R �'9i� iti.}YI•�Y/^ 14-:_ �.�!I'ir* � � �
FIXTURES NUMBER MAIN DRAIN _•' '.
UNITS FEES IUNITS I FEES
Water Heater I Size I.L T
Water Closets ` Material �,;••;,�
Bath Tubs To Gtirb_ 'w,
Showers' To. Propi',Line
Lavatories To Exist*n
Kitchen Sinks No oon
Dish Washers SEWER 80xE f
Waste Disposals -
Wash Trays STORM—DRAINAGE.. _T
Washing Machines .Size
Water Softeners Material
Bar Sinks To Main Drain ' ^'�,z.• ' '".
Comb. Sink a Trays To Curb I
Dental Units
e �
Driir4irig Fountains) l I ,.
1 .Drains WATER SYSTEM �—
Hoppers f Size
Restaurant Sinks Material
Sand Traps TOTAL FEES _` '•
Urinals Fixture Fee '.. .I- .=-+'
Area Drains Main Drain Fee
Water Leaders _° Storm Drain Fee
Sprinkler Valves Water Sys. Fee ,
- ��. 3.-,. . II Permit Fee I
TOTAL, �4 "-Il TOTAL FEE cL
R [ f
Partial Rough
R_�ugh complete •
Final Q !✓ _
K.
7VL
Bldg. Dept.
Office Copy
BUILDING I S ECTOR'S OFFICE
Cl 1 OF CUPERTINO
9--S-e,wer Connection Sanitary Permit No.
n Plumbing Final Plumbing Permit No.
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ofNo. ..... ................
Owner or Tenant --------- — I A� Q-.-1(!i
1(!i
4 _L ----- ----- -- -
At -------- .........
- ----------------------
Tract ---------------------- -----------
--Date Connected ...........................
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Date Final C--
pp
19-
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PLUMBING 41NPE
III 7/e1-500
1� 11.