51145 ,2 /V � :� LOT NO.
NO. ST11E.E1'
N a by LI TION FOR PLUMBING PERMIT
Z i t7/ Y OF CUPERTINO
Ya ���� Sanitary No.
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0 'a Uare July &—/zX01966 I9fi66 Permit No �/ `fS-
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w CITY. �� .�!�IDf p Fee $ '7L "v
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Applica n i the City of Cupertino for a permit to install Plumbing
`o < pipes and/or fixtures hste o1 Tf1c 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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4 Use of Premises HOUSEHOLD
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3 Owner JOHN BRAKE Address 21595 MONROVIA
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ZSOFTMASTER INC.
z By ' Address 1150 DELL AVE. , CAMPBELL
CONTRACTOR,AGENT
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30 Phone 379-5050
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uaa State License Approve
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U PLUMBING INSPECTOR I
FIXTURES
UNITS FEES UNITS1 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 11 Material
Bar Sinks To Main Drain
Com . Sink v Trays To Curb
Dental Units
Drinking Fountains
Floor ,Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee /, O o
Area Drains Main Drain Fee
eater Leaders Storm Drain Fee
7-pnnklcr Valves Water Sys. Fee —/. &-v
Permit Fee y.cij
TOTAL I TOTAL FEE p-d
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final