5120620060 Stevens Creek Blvd.
No. Street Lot No.
APPLICATI - a PL(JlvtBtl RMIT
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3 0 M8 s atMary No.
OCT
Date , 196_ Permit No��
f ,TV i� CUPERlIVFee s� 6
Application is hereby made tp the Ci 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.
Use of Premises
Owner Robert Ery
By West Valley PlbR & Ht�.
Contractor, Agent
Phone 556-48lo
State License 249656
Address 17470 Shelburne
Los Gatos Wy.
Approve /
Plumbing Inspector //
FIXTURES
NUMBER
MAIN DRAIN
Units
Fees
Units Fees
Water Heater
_
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To Prop. Line
Lavatories
To Exist'
Itchen Sink
NM
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
d, S-3
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
/
1•J
Fixture Fee
Area Drain
Main Drain Fee S O'J
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
Relief V-1ye
Gaq Fee a�
Vac Breaker
Skimmer
Filter
_
EA i- 4
of .�R .�
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Permit Fee D a
Total
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Total Fee - 'f a—