51145 (3) a/ 7& / I ^ — - LOT NO.
J �,NO. jO�C'�S'E6T�
jF L=APP\ LICA.TIONi FOR PLUMBING PERMIT
CITY OF CUPERTINO
Y o ��OV — 1966 ��� Sanitary Iib.
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0 < Dake October 27, 196Sz Permit No
fY OF Cl!PERT!�;0 Fee$
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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
1- 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.
w I
Use of Premises HOUSEHOLD
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3 Owner RALPH MC CORMICK Address 21761 SANTA BELLA P.
oa
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z By ROFTMASTER, INC. Address 1150 DELL AVE. CAMPBELL
O CONTRACTOR, AGENT
3 �
— 0 Phone 379-50Sf)
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s State Licens 3 Approved
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U ;/ PLUM�INSPECTO
/v_SC\
FIXTURES NUIN, BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To Cur
Showers To Prop. Line
Lavatories To Existing
Kitchen Si a Not Conn.
Dish Washers 11 Sewer Boxes
Waste Disposals
as Trays STORM DRAINAGE
aching Machines Size
Water So teners � /,fp Material
Bar Sinks To Main Drain
Tom . Sinks Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
a raps TOTAL FEES
nna s Fixture Fee /, re
rea rains Main Drain Fee
Nater Leaders Storm Drain Fee
Sprinkler ValvesWater Sys. Fee
Permit Fee ;;I.o-rl
TOTAL TOTAL FEE 7 ro
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
"Rough. Complete..
Main Drain
Final...