51234 107119 So. Blaney LOT No. 3
NO. STREET' o
CRY Of ru►ECRMD CITY OF CUPERTINO
W a JUN 8 �71T PLICATION FOR PLUMBING PERMIT
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x o Sanitary No.
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0 a I)a0 A ( D May 211 1971 Permit No '5-/ ? YC
i O Fees S.
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o 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
1- 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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a LL Use of Premises Apartments
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3 Owners@tome White Address 10159 So- Blaney
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J , By San Jose Mechanical, Inc, Address1665 Rogers Ave, S,J,
O CONTRACTOR, AGENT
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— Phone 275-90U
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o State License 20b 285 Approved
U� PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater % e.rc size S.vo
Water Closet d Lt.GO Material L r
Bath Tub I 1A on To Curb
Shower To Prop. Line
Lavatories d /1,001 To Existing
Kitchen Sink /2.0Not 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 la,v�✓
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee „fo
Relief Valve I Gas Fee
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Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee ,OD
Total ,So Total Fee ,S