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No. Street
CITY of CUPERTINO
APPLICATION FOR PLUMBING PERMIT
FEB 17 197CITY OF CUPERTINO
IQ
Sanitary No.
Lot No.
Date �� % , 19p Permit No. ��� G
Fee S -17V
Application is hereby made to the City of Cupertino for a permit to install plumbing 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 Cupertino, and all other
laws applicable thereto. ,
Use of Premises
Owner ,�,// Q Addressze?, Z„2
By LlX/ y Address
ConIP ctor, Agent
Phone o2/V'5/' %�.J-r
State License �/ 0�% -3 Approved
Plumbing Inspector
Dish Washer
Fees
Size
Curb
Floor Drain WA'
Hooaer Size
Total Fee
..�/ G � / Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO 7
File No.�1x� !
Sanitary No.
Date 196 7
Applica is hereby made for a�perm�it to l
`r a story. Type
to be occupie only a
in accordance with plot plan, Plans and Specification filed herewith,
Estimated Value of Improvements $
FEES Plan Check $
Owner Address
Contr. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEES
'Contr.. Address
Phone. State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date - p�i,9 196 7 GAS FEE $
PLUMBING FEE $
Cont,. p Address y/"
Phone — O State Licenses /8 y9Z 7-
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 1% FEES
Contr. Address
Phone State License
Approved -
Applicants agree not to violate any of the. 'N.
Workman's Compensation Laws of the
State of California
RECORD OF INSPECTION APPROVALS
FOUNDATION BUILDING
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Date Ins pe star
LATH & PLASTER
Oa to Inspector
FINAL
Date Insoecfor
ELECTRICAL
,OUTLETS
SERVICE SIZE
SWITCHES. UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
Date Inspector
FIXTURES FINISH WIRING
N.P. CHARGE FIXTURES Date Ins pecfor
Dote Inspector
PERMIT FEE Motors
Dote Inspector
TOTAL FEES FINAL
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE MATERIAL
STORM DRAIN SIZE MATERIAL
WATER SYSTEM SIZE I- T.ERIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Date Inspector,
MAIN DRAIN FEE ROUGH COMPLETE
Dote Inspector
STORM DRAIN FEE - MAIN DRAIN
Date Inspector
WATER SYSTEM FEE GAS PIPING
Date e
GAS PIPING FEE FINAL
Date nape ctor
PERMIT FEE MISC
Date Inspector
TOTAL FEE MISC
Date Inspector
APPLIANCE
TYPE OF APPLIANCE UNITS FEE TYPE OF APPLIANCE UNITS FEE
CIRCULATING HEATERS REGISTERS
BLOWER FURNACES COMBUSTION VENT
SUSPENDED UNIT MISC
GAS RANGE MISC
GAS DRYER PERMIT FEE
FLOOR FURNACE TOTAL FEE
INSPECTED
Date Inspector
LOT NO.
NO. STREET
AP,PLIQATI6N F,Cilt PLUMBING PERMIT
w / `= i CCT SOF CUPERTINO
z o t Sanitary No.
I W - �' .j %
o Date ,x196— Permit No
3 a
0` rl! t� C Fee$ O ^�
Applcation is herebytmade10Pt!@City of Cupertino for a permit to Install plumbing
`o a pipes and/or fixtures listed ori 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
<w Cupertino, and all other laws applicable thereto.
oo Use of Premises �1T��«' / / !
�
3 Owner � / o' / �7/>7/ iE'Address�i
Address-
2
ddres
By �i ��1 / 2 Yz osv<v. yr
-q s
J O v CONTRACTOR, AGENT
- 0
— am Phone
w w-- G
01 State License2e f' Approvedeef -
r+ U PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
_ UNITS FEES UNITS FEES
Wnter Ileater Size
Water Closet Material
Both 'rub To Curb
Shower To Prop. Line
Lavatories '['o Existin
Kitchen Sink Not Conn.
- Dish Washer Sewer Dox
Waste Disposal
Wash Tray STORM DRAINACL
Washing Machine Size
Water Softener Material
Bar Sink' To Main Drain
Comb.Slifik&Tray To Curb
Dental Unit
Drinking Fountai n
Floor Thain WATER SYSTEM
Hopper Size _
Restaurant Sink Material
Sand Trap 1110'rAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Belief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee