51234 10119 So Blaney LOT NO. 15
NO. STREET
CRY OF CUPERTINO CITY OF CUPERTINO
" a APPLICATION FOR PLUMBING PERMIT
r o JUN 8 1971 Sanitary No.
LL May 211 5 3 }c
0 a Date 19 11 Permit No
3 O Pee S
2 LL
0 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
r 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.
W x
Use of Premises Apartments
00
�
3 Owner Jerome White Address 10159 So_ Blaney
o <
ZJ
� , By San Jose Mechanical, Inc, Address 1665 Rogers Ave., S.J.
O CONTRACTOR, AGENT
3 r
w i Phone 275-9041 i�
ao State License 264285 Approved
PLUMBING INSPECTOR /
FIXTURES NUMBER MAIN DRAIN
Units Feesff,51
Fees
Water Heater /. Size .pU
Water Closet Sae MaterBath Tub P /a,oa To CuShower P i .00 To PrLavatories .s To ExKitchen Sink i.2.ol N t C
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 1�i e
Restaurant Sink Material aA,vll
Sand Trap TOTAL FEES
Urinal Fixture Fee ,SD
Area Drain Main Drain Fee So.r
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee /SA
Relief Valve 11 Qa�Fee
?O
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee 1•OU
Total PS,SU Total Fee