51037 LOT NO.
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t `SPP 11C'A<TI • N FOR PLUMBING PERMIT
z a IOY OF CUPERTINO
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0 Uatc _Nov 12 96 5 Permit No. J /O S 7
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CITY ur UUPLK 11146 Pec S 4.00
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Application is hereby made to the Cit}' 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
wCupertino, and all other laws applicable thereto.
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LL Use of Premises DWELLING
00
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3 Owner BEN STILLMAN Address 11165 LA PALOMA DRIVE
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Z J FIM
SOASTER INC.
By ' Address 1150 DELL, CAMPBELL
CONTRACTOR, AGENT
3 �
Phone 379_5050 /
ao State License 234281 Approved-
U PLUMBING INSPECTOR
FIXTURES 1
UNITS FEES UNITS FEES
Water Heat, Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Disn Washers Sewer Boxes
Waste Disposals
\tt S_h Trays STORM DRAINAGE
Washing Machines Size
Water Softeners 1 Material
Bar Sinks To Main Drain
Com . 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 if
.-100
Drains Main Drain Pee
V\/ater Leaders Storm Drain Fee
�prink�cr Valves Water Sys. Fee 1.00
Permit Fee 2.00
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final