51179N
10131 DEEPROSE PL, LOT
NO. STREEt—j
APPLICATION 'FOR PLUMBING PERMIT
y 1QUO CITY OF CUPERTINO
i� rr rr�UG 13 t.,Sanitary No
Date .fitlll L? 116k Permit No
Pee$
-S�
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 _ HOUSEHOLD
OwneKAYNE K. HEPPLER Address 10131 DEEPROSE PL.
By Offl; IJIA ST Rt nr
CONTRACTOR, AGENT
Phone 379-5050
State License el
C-' 3C 4' C -mss
Address P.O. Box 696
Approved
PLUMBING INSPECTOR
Watet Heate
Fixture Fee
Fee
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
:Main Drain
Final .