51124 (2) ,2° 3 t,3 LOT NO.
NO. MEET
APPLICATION FOR PLUMBING PERMIT
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wCITY OF CUPERTINO
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x o Sanitary No. _ w
0 a Date September 1 1961 Permit No �1
3LL Fee $
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
`o < pipes and/or fixtures listed on the reverse side hereof, and agrees to'install said prices
r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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j Use of Premises HOUSEHOLD
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3 Owner W. R. Timbers Address 20343 Gillick Way
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J , By Coast Water Softener Co. Address 807 The Alameda (S.J)
O CONTRACTOR, AGENT
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Phone X9,5--3y�s—
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f State License /23 KO-3Approveda 0
—0 PLUMBING INSPECTOR
FIX I Umhb NUN BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners (j Material
Bar Sinks To Main Drain
Cont . Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee p O
Area Drains Main Drain Fee
mater Leaders Storm Drain Fee
Sprinkler valves Water Sys. Fee /, 0 p
Permit Fee Zpa
TOTAL TOTAL FEE Cf.O'o
RECORD OF INSPECTION
Underground Rough.,.
Partial Rough..
Rough. Complete..
Main Drain
Final...