51078 /o �zg6- I1x� t -
NO. T Q
D 11"FOR PLUMBING PERMIT
d I Y OF CIJP17RTINO
Yw � JUL 28 1965
Sanitary No.
RLLa
Io jDate � vLV 96Permit No r/D
7
3 CITY OF CUPERTINO
w LL Fee S /
= o
Application is hereby made to the City of Cupertino for a permit to install plumbing
01 pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> I 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 = J a
,. Use of Premises Sem✓��� CS�'�D�
00
3 Owner/ X84 �L Address J
oz By ( �� Address
CONTRACTOR, AGENT �
37P� — 77,
Phone
w z z
w w
o a C 3(0 2/335 2 Approved
o State License
�\ PLUMBING INSPECTOR
FIXTURES 1
UNITS FEES UNITS1 FEES
Water Heate Sae
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line I/
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain q..r
Com . Sinks Trays To Curb
Dental Units
Drinking Fountains .
Floor Drains WATER SYSTEM
Hoppers Size I I�4-
Restaurant Sinks Material
SanJ Traps TOTAL FEES
Urinals I Fixture Fee
Area Drains an Drain Fee
later Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee ,00
Permit Fee p O
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final .