51114 / / �z / /& - LOT NO.
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140. STIUIET
APPLICATION FOR PLUMBING PERMIT
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z CITY OF CUPERTINO
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r o Sanitary No.
0 September 21
o Date 19664 Permit No
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w Fee $
To
� 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
a 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 HOUSEHOLD
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3 Owner E. R. Miller Address 19749 Mnrrlfr Dr.
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Z, Coast Water Softener Co
Z By C 6a Address
3 N Phone. SAN JOSE 26, CALIF.
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o State License / 2 3 sea 3 Approved
UAIV PLUMEING INSPECTOR
FIXTURES
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
as'h Trays STORM DRAINAGE
Washing Machines Size
Water Softeners / /.do 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 400
Area rains Main Drain Fee
ZV/ater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee 96
Permit Fee
TOTAL TOTAL FEE y,p
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final...