51234 10169 I So. Blaney LOT NO, 4
NO. STAEE.'r d - A's
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CITY of CUPERTINO CITY OF CUPERTINO P ,
" a PPLICATION FOR PLUMBING PERMIT 3— D�
w X JUN 8 191
x o Sanitary No.
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o < U; �V 211 , 19 � Permit No
00 Pee S
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Application is hereby- made to the City of Cupertino fora 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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a Use of Premises Apartments
00
3 Owner Jerome White Address 10159 So- Blaney
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By. San Jose Mechanical, Inc_ Address 1665 Rogers Ave_ S_J_
CONTRACTOR, AGENT
30
— o Phone 275--90)1)1ww¢Q fWp
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a nIYCU5State License
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lf' PLUMBING INSPECTOR
4 - a•: Z - B': 3 - �S
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater / I.s,011 Size
water Closet /A jf.00 Material L r
Bath Tub li /dsa To Curb
Shower 3 lsol To Prop. Line
Lavatories / P.#& I To Existing
Kitchen in /3-VA/3—VA 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 % "
Restaurant Sink Material 6,9,vii
Sand Trap TOTAL FEES
Urinal Fixture Fee d
Area Drain Main Drain Fee 07,10
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
Relief Valve I Gas Fee
SD
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee ,. 00
Total e f,Ve Total Fee 7 9,OP