51234 (4) 10159 1 So, Blame LOT NO. RPC, R]rig.
NO. STREET
CITY OF CUPERTINO Vy
w errr of cuveRrAPPLICATION FOR PLUMBING PERMIT
r o JUN B 1971 J:mitary No.
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oa pate _ May 24 19 Z Permit No
3 U Fee $
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Application is hereby made to the City, of Cupertino for a permit to install plumbing
°o 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
a w Cupertino, and all other laws applicable thereto.
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w Use of Premises Rec. Bldg
00
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oa Owner Jerome White Address 0159 Sn- F7lane;
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j , By San Jose Mechanical, Inc. Address 1665 Rogers Ave-
, CONTRACTOR, AGENT
3275-9044
— m Phone �♦ -
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a�oState License 264285 Approved
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-q) PLUMBING INSPECTOL,'-�
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater 50 Size il^ xe)
Water Closet -3 f�--o Material c i
Bath Tub / /s0 To Curb
Shower A 300 To Prop. Line
Lavatories 3 ..rO I To Existing
Kitchen Sink S'O I Not Conn.
Dish Washer
.Waste Dis osal
Wash Tray STORM DRAINAGE
Washing Machine * A 9w Size
Water Softener Material
Bar Sink rs0 To Main Drain
Comb.Sink&Tray To Curb
Dental Unit.
Drinking Fountain
Floor Drain / /50 WATER SYSTEM
Hopper / Size i "
Restaurant Sink Material G2.✓
Sand Trap TOTAL FEES
Urinal Fixture Fee 20.00
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee I TO
Relief Valve ii Qa%Fre
/.S
Vac Breaker
Skimmer
Filter
Pool Sweeper
Pens. .S mm / 1.SD
Permit Fee J.ID
Total e,0 Total Fee o D