51189o
j
No. Street
jaill CATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
f NOV 3 1970 Sanitary No.
Lot No. 4 D
4 — F oN irs
9 - B l",rr
Datel \ 1930 Permit No. /I�
CITY OF , Fee $ 2';;90-
Application is hereby made to the City of Cupertino for a permit to install plumbing 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 Cupertino, and all other
laws applicable thereto.
Use of Premises QtP'"`5
Owner A -u j (2� c i w aT. lin .
By SR 30r.0 YfELN'A icAt. We
Contractor, Agent
Phone �2"l� 6l04L'
i
State License '2 64 ZR � )
Address
Address I6I.S R&Gxgs kir, SJ
11-19 7n
Approved
lumbing Inspector �—
TURES
NUMBER
MAIN DRAIN
Units Fees
Units Fees
r Heater
Size. �"
9.
r Closet
11
Material GI
Tub
$
To Curb
er
$
To Prop. Line
tories
12
To Existing
$Not
C nn
Washere
Dis osal
Inta
Tra
STORM DRAINAGE
hin Machine
Size
r Softener
Material
Sink
To Main Drain
b.Sink & Tray
To Curb
tal Unitking
Fountainr
Drain
WATER SYSTEM
Hopper
Size 1
Restaurant Sink
Material G
Sand TrapTOTALFEES
Urinal
Fixture Fee
-1ti
Area Drain
Main Drain Fee
S �=
Water Leader
o Dain Fee
Sprinkler System
Water Sys. Fee
Si
Relief Valve,
Gas Fee
of
Vac Breaker
Skimmer
Filter
Permit Fee
v o�
Total
t}
Total Fee
15'0