51088.1 LOT NO.
CRY OF Ctll cnTINO STREET
CITY OF CUPERTINO
04SEP 21 1971 APPLICATION FOR PLUMBING PERMIT
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3LL a R)at�'` ' , 197/ Permit No 1:31 ./
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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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a ~ Use of Prem"Ses
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CONTRACTOR, AGE
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m Phone__honey�Gb'-los 7!0 7Jia`U w
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� s State License•-�3•�7J Approved
PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater / Size
Water Closet 1.1,64 Material
Bath Tub To Curb
Shower To Prom Line
Lavatories 1.2,6DI I To Existing
Kitchen ink 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
Restaurant Sink Material
Sand TrapTOTAL FEES
Urinal o Fixture Fee i
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee O
Relief Valve 11 Gnq Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee .60
Total f 15` Total Fee �"