51137 /l'L1141 I F'4 2 h
LOT NO,
NO. STREF.I'
APPLICATION FOR PLUMBING PERMIT
OF CUPE'T'") CITY OF CUPERTINO
TW Z
TT1 C 9 0 1971 Sanitary No.
o Date ��—y`r 19�L Permit No. -5'11907� a ^
T oP D Pee S 3.
Application is hereby made to the City of Cupertino for a permit to install plumbing
apipes 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
W Cupertino, and all other laws applicable thereto.
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0 LL Use of Premises
00
3 Owner I ky si 4-L- a. Address -20,077 LARODA CT
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By./f cCP�3G .Sc2 lrF '('Z'a."� q AddressJ76 &Ifl'fneu7 4L' TIJ
O CONTRACTOR, AGENT
3N Phone 2- 57 7 b'/o7
s State License 2 37 5o8 Approved
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. IPLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater ,LTJ Size
Water Closet Material
Bath Tub To Curb
Shower To ProD. Line
Lavatories To Existing
Kitchen in N [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 Fixture Fee %.) G
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee
Relief Val��, 11 Gaq Fee,
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee .2. 1
Total Total Fee 13, Sb