51234 20060 ( Rodrigues LOT NO. 12
NO. STREET
CITY OF CUPERTINO
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APPLICATION FOR PLUMBING PERMIT
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' 0 JUN 8 1971 Sanitary No.
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O a [)ate may 2119 Z Permit No
1 LL P Pee $�L.
o Application is hereby made to the City of Cupertino for a permit to install plumbing
0 : pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
s and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a m Cupertino, and all other laws applicable thereto.
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Use of Premises _ AparfnPn,}c
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3 Owner Jerome White Address 10159 So_ Blaney
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J , By. San Jose Mechanical, Inc, Address 1665 Rogers Ave_ S_J_
O CONTRACTOR, AGENT
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- 0 Phone 275-2044
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a o State License. 264285Approved
u PLUMBING INSPECTOR
FIXTURES INUMBER 11 MAIN DRAIN
Units Fees 11 Units Fees
Water Heater / J,nd Size S,
Water Closet ,20 l3a0d 11 Material C /
Bath Tub /.Z l/go,911 To Curb
Shower 7 1/.10,011To Prop. Line
Lavatories .10 3000 To Existing
Kitchen Sink /1 A Not Conn
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Re "
Restaurant Sink Material a�✓
Sand Trap TOTAL FEES
Urinal Fixture Fee ,/0950
Area Drain Main Drain Fee J.0o
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee /,so
Re]qef Valve ii Ga,Fee /.5 10
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee .20D
Total /oq, Total Fee all 9,