NO PERMIT NUMBERLOT NO. 12-6
PLUMBING PERMIT
�ITY-OP C:UPERTINO
IAUG
4 l68Sanitary No.
p /
Date n - o p 196r; Permit No
Pee $ �
Application is hereby made toj�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 //Pr��emiises// R6' S
Owner �_I.1�1�� Address
L'wtbra!'s wiU 0'n., Q u.
By Address
cNT
Phone San Jose, California 95112
WILLIAM D. BENEVICH
State License 1-71T3 i Approved
V PLUMBING INSPECTOR
dCa FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater / /-SD Size
Water Closet o`t- 3.00 Material
Rath Tnh / /,,'7) T. G..6
Shower I / I / SD 11 To Pro D. Line I I
Kitchen Sink / /. Sp ( Not Conn. I I�
Dish Washer Sewer Box
Wash fray I 1 11 STORM DRAINAGE i
Washing Machine % /.$D 11 Size
WATER SYSTEM
Water Softener Material
Hopper
Bar Sink To iMain'Drain
Comb.Sink&Tray To'Curb
Material
Dental Unit
Sand Trap
Drinking Fountain
Urinal
Floor Drain
WATER SYSTEM
Hopper
Size P,
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
JC MD
Area Drain
Main Drain Fee
S Q
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
as Fee
Vac Breaker
Skimmer
Filter
Total 1 /D 1 /5e)0jj Total Fee 4,SOU