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Plumbing Permit 11011 I Bubb Road / LOT NO. NO. STR F.F,i' za APPLICATION FOR PLUMBING PERMIT Z Z TY U o3 ¢ U.rO © 0L%1 - 19N Dare Sept. 27 U Pee $ 3. 50 1a 0 Application is hereby made to the City, of Cu ertino for a permit to install plumbing `o a pipes and/or fixtures IistecllTlAie Grs�sUP `�t} agrees to install said prices > and/or fixtures in accordance with the provisions o the umbmg Code of the City of a W Cupertino, and all other laws applicable thereto. wx Use of Premises Private Residence 00 3 Owner Don J. Leonard Address 11011 Bubb Road zj Culligan Water Conditioning Y of Los Gatos Address 611 University CONTRACTOR, AGENT Los Gatos Calif. 3N Phone 354-1845 WW a 216217 0 State LicenseAppved o _ O} U PLUMBING INSPECTOR FIXTURES NUMBER MAIN DRAIN UNITS FEES UNITS FEES Water Heater Size Water Closet Material Bath Tub To Curb Shower To Prop. Line Lavatories To Existing Kitchen Sink Not Conn. Dish Washer Sewer Box Waste Disposal Wash Tray STORM DRAINAGE Washing Machine Size Water Softener 1 1. 50 Material Bar Sink To Main Drain Comb.SinkBTray To Curb Dental Unit Drinkin Fountain Floor Drain WATER SYSTEM Hopper Size Restaurant Sink Material Sand Trap TOTAL FEES Urinal Fixture Fee Area Drain r Main Drain Fee Water Leader � ,!�" i'� Storm Drain Fee Sprinkler Valve �� (7 Water Sys.Fee Relief Vnlve Gas Fee Vac Breaker Skimmer Filter `�� Permit Fee 12.00 Total Total Fee11 1