51133 / O / 7 S— A2,j LOT NO.
NO. - sTfu_. -
g� A�P�iI ATION FOR PLUMBING PERMIT
" Y OF CUPERTINO
x 0 �AU(a j D Sanitary No.
4 t966
Date J-u�� 3 196— Permit No Uhl 234281 b��3
3
w Fee $
T
r Aicatlo�lt�S�yRe�f e to the City of Cupertino for a permit to install plumbing
`o a pipes and/or fixtures hste on the reverse side hereof, and agrees to install said prices
i m 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.
wx
4 Use of Premises HOUSEHOLD
00
R. W. COOPER
0 3 Owner Address10175 VICKSBURG DRI.
0a
z
z By SOFTMASTER, INC. Address 1150 DELL AVE. , CAINiPBELL
0
3 F CONTRACTOR, AGENT
- Phone 374-5050 Q/�( /�
ao It`'tate License Approved6d64_- � J
u„t I PLUMBING INSPECTO /
FIXTURES NUMBER MAIN I
UNITS FEES UNITS FEES
Water Heate Size
Water C osets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
as
Trays STORM DRAINAGE
Wasing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sinks rays To Curb
Dental Units
Drin ing Fountains
Floor Drains WATER SYSTEM
Hoppers ze
Restaurant Sinks Material
San raps TOTAL FEES
nna s Fixture Fee 400
T,—ea Drains Main Drain Fee
Water Leaders Storm Drain Fee
�prinklcr Vatvcs Water Sys. Fee 400
Permit Fee y. OL)
TOTAL TOTAL FEE . dc)
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final .