100042 (6) LOT NO.
N
n
N FOR PLUMBING PERMIT
J U L 12 1965 11
TY OF CUPERTINO
Dat �, 191 5� Permit Nozo (J c) yC
CITY OF CUPWIFee $ C'V
Application is hereby made to the City of Cupertino for a permit to install plumbing
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
Cupertino, and all other laws applicable thereto
Lr Use of Premises—
Owner
remises Owner Address
gy Address
�✓/ � CONTRACT R, AGENT A roved
Phone /V G h'93,�' _ PP PLUMBING INSPECTOR
SURES UMBER a MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closets I Material
Bath Tubs To Curb
.Showers I To Prop. Line
Lavatories To Existin
Kitchen Sinks No Conn: 7.,
Dish Washers ' �—
Waste Disposals
Wash Trays I I STORM DRAINAGE
Washing Machines Size
Water Softeners Material I j
Bar Sinks To Main Drain
Comb. Sink a Trays To Curb
Dental Units I�
Drinking Fountains) II _
Floor Drains I WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee T
Area Drains I Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Vaives I I I Water Sys. Fee
Permit Fee . C�6
TOTAL TOTAL FEE )V
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final —