51037 11145 1 LaPaloma Dr. LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
z
r o Samtar No.
3 aDate 196 No d41 7
W U Pee $ 44 ftr
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� Application is hereby made to the City of Cupertino for a permit to install,plumbing
o a 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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W Use of Premises residence
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> 0 Beulah Stetler 11145 LaPaloma Dr.
r 3 Owner Address
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z By COAST WATER SOFTENER CO. Address 807 THE ALAMEDA
CONTRACTOR, AGENT
3 m Phon�92 3435
W2
E State License /,13 Approve
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—0 PLUMBING INSPECTOR
riXTUIR75-- NUMBER 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 Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
I=loor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
rea Drains Main Drain Fee
mater Leaders Storm Drain Fee
Jprinkier Valle: Water Sys. Fee
Permit Fee —
TOTAL TOTALFEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final...