51043.1 (17) ma LOT N
NO. S"EF.
?(4
IOPLUMBING PERMIT
IUPERTINO
s z Sanitar No.° PR 12 19 y
3 Date —� . 1968 Permit No J-/() <,-3,1
U Fee $ 7a �D
' 0 C1TYpliM. cup'ERTIn to the City of Cupertino for a permit install plumbing
W
r pipes and/or fixtures liste 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
wCupertino, and all other laws applicable thereto.
w x
0 LL Use pf Premises
> N
3 Ownery r '7_' ' — Addressp� °
oBy. C tau(�7ft1'd�r'�'4ssC;g`. 9A
3 CONTRACTOR,AGENT 625 Charles Street
- Phone —WX-C.Ss6 San lose, California 95112
wZ
ww
s State License-'X y 7/� 3 Approved
ao�—U PLUMBING �SPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater I ISize
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen ink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Plain Drain
Comb.Sink R Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap 'TOTAL FEES
Urinal Fixtare Fee G 7 -5-0
Area Drain \lain Drain Fee o
Water Leader Storm Drain Fee
Sprinkler Valve Water s.Fee J'd
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee d d
Total 7..s?� Total Fee 7 d