51175/d�9y 70/1,-*� L�
LOT NO.
NO. STR F. F.I'
LIPLIP C�ITIOPhF�OR PLUMBING PERMIT
tCilTY OF CUPERTINO
s R f SEP 15 1967 Sanitary No.
Y O _
a < Date ,19� Permit No
3U
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Application is herebp'h» d he 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 4i! _
4kacaL�
By ACTOR,AGENT
Phone -3 7q --R,?
State License a L a l 7
I
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Approved
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PLUMBINGfINSPECTOR
1 /t
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Heater
Size
Water Closet
Material L
Bath Tub
L
To Curb
Shower
To Prop. Line
Lavatories
To Existing
Kitchen ink
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
L
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size I
Restaurant Sink
Material Gy
Sand Trap
TOTAL FEES
Urinal
Fixture Fee 7
Area Drain
Main Drain Fee ,S'v J
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee / Sw
Relief Valve
as Fee /-3
Vac Breaker
Permit Fee 6Z
Total 2o_f 1 Total Fee 13 7 O d