51145 (2) 21681 Lindyy Lade LOT NO.
NO. STREF.I'
�A�PPCIG° TON FOR PLUMBING PERMIT
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o z iITY OP CUPF. Sanitary
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0 ' Date ���dC T156 196 6 Permit No
u Fee $ 4.00
0 C911Yilicafn iCAJAERTMtothe City of Cupertino for a permit to install plumbing
o 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
a w Cupertino, and all other laws applicable thereto.
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Use of Premises HOME
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3 Owner JOE DOUCET Address 21681 Lindy Lane
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By C.W.C. of Los Gatos Address 611 Univ.Ave.
O CONTRACTOR, AGENT
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- < Phone 354-1845
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6128
0 F State License Approved .I
a U` PLUMBING INSPECTOR V
F IXI URESNUMBER
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 ?.00 Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Nater Leaders Storm Drain Fee
Jprinkler Valves Water Sys. Fee 2.00
Permit Fee
TOTAL TOTAL FEE 4.00
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final