51087 (2) 1071 da Vista Dr. LOT NO. 3
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ON FOR PLUMBING PERMIT
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x o Sanittry No.
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t 196 Permit No_-16
"%V' CTR�R INT
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o 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
i m 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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.. Use of Premises Residence
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3 OwnPrranklin-Bahl Const AddressP•OBox 911,Campbell
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By Central Service Co Inc. Add ress451 Queens Lane. SQJT.
CONTRACTOR, AGENT
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— Phone 29$-0556
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a o State License ���6,� Approved WILLIAM D. G_NEVICH
U f I PLUMBING INSPECTOR ��
I. I UR�S NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Hcatc /,Q O Size
Water Closets 2 a e Material G7
bath Tubs / oa To Curb
Showers f / po To Prop. Line
Lavatories 3 v, To Existing
Kitchen Sinks / .; Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Ks'h Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink--, Trays To Curb
Dental Units
Drinking Fountains
floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material 6 pA,
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee e
Water Leaders Storm Drain Fee
3prinklcr Valves Water Sys. Fee rvo
Permit Fee i ,ap
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Fina .