51087 (2) 10790 LINDA VISTA LOT NO.
NO. ST1EF.I'
APPLICATION FOR PLUMBING PERMIT
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ITY OCIPhRTINOz -
y p ' f - � j \. Sanitary No.
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3 < Date Q q, I 196M Permit No.
w Pee $ 8 3
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n w A plication i�hereb� m� t City of Cupertino for a permit to install plumbing
0 `a pipe��r�dfor� rtur s I reverse side hereof, and agrees to install said prices
i I 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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LL Use of Premises HOUSEHOLD
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3 Owner HAROLD RANSOM Address 10796 LINDA VISTA
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z By SOFT-MASTER, INC. Address 1150 DELL AVEN, CAnPBELL
CONTRACTOR,AGENT
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- Phone 379-gO50
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coSta[e License 21L•281 Approved
—U PLUMBING INSPECTOR
F1. NUMBER
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
%Vater Softeners Material
Bar Sinks To Main Drain
Com . Sink 4 Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San raps TOTAL FEES
Urinals Fixture Fee
rea Drains Main Drain Fee
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`Vater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee G7.O d
TOTAL TOTAL FEE 3,f
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final