51120 e No. Street Lot No.
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17
UAN 0 J TION FOR PLUMBING PERMIT
CITY OF CUPERTINO
1970
Sanitary No.
E DTate _ / IAI-0 Permit No>r-11�
3 L� 1 I Fee S'0
r 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
o in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
1.2 laws applicable thereto.
Use of Premises
R� S
o w
' 0 Owner Address/06'a`j' �Qi/-exp io�t.
0
c ro
BY ( / e R I�/n/O �G UM B/n/s- Addresses 0 S/L d6R.�p.+
3 y 7 Contractor,Agent
°' ° Phone :253—cy6 8
State Licensez 2— SAO 3 Approved .iJ1 p, )rte,,f-•,/IC
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 in 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
Hoper Size
Relief Va
lve
Restaurant Sink Material
Sand Tra TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Wate Leader Storm Drain Fee
Sprinkler System Water Sys.Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee
/40 j I -4 i6, L(�-�� Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
P' File No.
00, nitory No.
Data 196
Appllca tin isAheree to story, Type
to be occupied only as
.accordance with Plot Plan, Plans and Specification filed herewith.
Estimated Value of Improvements $
FEE$ Plan Check $
Owner _7..t .. i 9/ .0 .(, Address/etz �7 R/t-F--e-��-.. • i 'y"j
Contr. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date 196 FEE$
Contr. Address
Phone State License
Approved
T�ON• PL 1� ING & GAS PERMIT
Dare 'V 196j��] t GAS FEE $
Y OF Uf W PLUMBING FEE $
Contr. / / p Address
Phone ''- �.S o2 - (0 �0 State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date 196 FEES
Contr. Address
Phone State License
Approved
Applicants agree not to violate any of the t
Workman's Compensation Laws of the
State of California
RECORD OF INSPECTION APPROVALS
BUILDING
FOUNDATION
Date Inspector
UNDERFLOOR
Date Inspector
FRAME
Date Inspector
LATH & PLASTER
Date Inspector
FINAL
Date Insoector
ELECTRICAL
.OUTLETS
SERVICE SIZE
SWITCHES UNDERGROUND
Date Inspector
RECEPTACLES ROUGH WIRING
Data Inspector
FIXTURES FINISH WIRING
Date Inspector
M.P. CHARGE FIXTURES
Date Inspector
PERMIT FEE Motors
Date Inspector
'TOTAL FEES FINAL
Date Inspector
PLUMBING & GAS
MAIN DRAIN SIZE I MATERIAL
STORM DRAIN SIZE JITERIAL
WATER SYSTEM SIZE RIAL
TOTAL FIXTURES UNDERGROUND
FIXTURE FEE PARTIAL ROUGH
Dote Inspector
MAIN DRAIN FEE ROUGH COMPLETE
Data Inspector
STORM DRAIN FEE MAIN DRAIN
' Data Inspector
WATER SYSTEM FEE �- GAS PIPING
Data Inspector
GAS PIPING FEE FINAL
Date Inspector
PERMIT FEE ,._ � MISC
�d'p ate napector
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
LOT NO,
NO. STREET
APPLICATIOWFOR PLUMBING PERMIT
CITY OF CUPERTINO
�\ Date 194� Permit No.
Fee $ T 0
fApplication 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. SS1 pc
GOLBywner s�n 1 Address�,V_ /�/�O/r111�0/Ce �� r
a ds Address. /7 e� U1k�� 4AGENTone ��)��7 Approved
I PLUMBING INSPECTOR
S N
0 o w 'T� °'. •rl a. � �'c .d S � /may n 7�'
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