51234 10129 I So. Blaney LOT NO. 16
NO. STa F.F.I'
40 CITY OF CUPERTINOdi (�
" < cm °F c��R APPLICATION FOR PLUMBING PERMIT 0
x a JUN 8 1971 - sanitary No.
oa [)are 52L171
39 — Permit No /� 3
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� 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
o a Owner Jerome White Address 10159 So_ Blaney
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By San Jnse Mechanical Inc, Address 1665 Rogers Avenue -
O CONTRACTOR, AGENT
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- < Phone 275-9064
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a o Stale License 2 285 APPr`o/ved
-\ PLUDIBING INSPECTOR . /
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet .26 9ao0 I Material (:j
Bath Tub 1A /Y.oO To Curb
Shower f IgoeTo Prop. Line
Lavatories .06 3,0.po To Existing
Kitchen Sink /YAO 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 i 1 "
Restaurant Sink Material 4,9�✓
Sand Trap TOTAL FEES
Urinal Fixture Fee .10
Area Drain Main Drain Fee of
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee „rp
Re]qef Valve Caq Fee f0
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total / .sc Total Fee