51119 LOT NO.
O N APPLICA FOR PLUMBING PERMIT
w i ,,JUN 10 1965 TY OF CUPERTINO
' 0 / Sanitary No.
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3 a Pe'r{L' +�TMO, 196—��� Permit No
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
o < pipes and/or fixtures listed on the 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.
,. Use of Premises
00 ( C I
3 Owner Oct, Ln" G 1 S Address 0 3 S� `, C 1 V 4(2LR"c
� z By �Uf—' 't `/VQ J S Address
O CONTRACTOR,AGU4T
3 < ak4-�Srs
— 0 Phone
a State Licens `/ —7 9 / 1"( Approved
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Ut\ PLUMBING INSPECTOR
FIXTURES NUIN BER MAIN DRAIN
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
Wasli Trays STORM DRAINAGE
Washing Machines Size
Water Softeners ' Material
Bar Sinks To Main Drain
Com . Sinks Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers ji Size
Restaurant Sinks Material
San Traps . TOTAL FEES
Je[ciaals� .(.'y c^-e Fixture Fee' c'
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
c—o Permit Fee L-
TOTAL TOTAL FEE C'r
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final....