51234 10109 I So. Blaney LOT NO. 17
NO. STREEI'
CITY OF CUPERTINO H B
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w < crrr of cuPEUA&PLICATION FOR PLUMBING PERMIT
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x ° JUN 89 Sanitary No.
4
oil Uatr 5�2 , 19 — Permit No �/ 13
IC P A I D Fee $
LL
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
> I 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.
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Use of Premises Apartments
00
3 Owner Jerome White Address 10159 So_ Blaney
oa
zJ 1665 Rogers Ave
By San Jose Mechanical, In. Address g
CONTRACTOR, AGENT
3 �
- 0 Phone 275-90U L n/�
a V-1-_ f /
a o State License 264285 Approved
—0!,L LUMBING INSPECTOR':
of 413
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater / Ar,91 Size �/" -57,0e)
Water Closet 14.ob Material a/
Bath Tub 1.24n To Curb
Shower To ProD. Line
Lavatories •P io.en To Existing
Kitchen Sink Jr I-v4ol Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size , '
Restaurant Sink Material Csw
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water LeaderStorm Drain Fee
Sprinkler System Water Sys.Fee -X4
Relief Valve II Gas Fee 5n
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee 1.O ii
Total *..5o Total Fee S ,JO