NO PERMIT NUMBER1,014 ;L I_ ItGM / � LOT NO. 2"L/
No. I ' r STREET
APP ' AJITIONl FOR PLUMBING PERMIT
5
CITY OF CUPERTINO AUG 1//2 i%8 Sanitary No.
/`
Date '•• - b 196F Permit No
• ) Pee $ a
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 lows applicable thereto.
Use of PremisesRa Si
CONTRACTOR, AGENT 625 Charles Street
Phone CO t o SS` San lose, California 951VVILLIAM D. BENEVICIH
State Licence f % )S 3
v PLUMBING INSPECTOR 1z
FIXTURES
NUMBER
([J MAIN DRAIN
UNITS
FEES
UNITS FEES
Waterlleater
i,sa
Size 211e •U6
Water Closet
c;I,
3t cvo
Material
Bath Tub
D
To Curb
Shower
/-S-D
To Prop. Line
Lavatories
3
14"o
To Existing
Kitchen Sink
c
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
/.
Size /
Water Softener
Material
Bar Sink
To Main i
Comb.Sink & Tray
ToQ65b
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material qf...
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee Qe
Water Leader
Storm Drain Fee �-
S rinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Feel d('
'Total Fee g�