51001.2 ,/�/ ". - /t[ r/J 'w . LOT NO.
NO.:- !,Z STREET
-APPLICATION,�FOR PLUMBING PERMIT
BSEP 1957 CITY' OF CUPERTINO
Dake �1' SEP 22 196{7 195— Permit No. S� O o /, Z
UJ (r(l�E�`���l:'r) Fees -7--TV
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.
Use of Premises
'a
h Owner /J /J Address/21•.�Q�(�+�•i-fe �'+/✓—���^`
BJ U^'r Address.�1?O I".c�C,C.i.iry l JiN. .
CONTRACTOR, AGENT
II Phone Approved
pprov d
C
PLUMBING INSPECTOR lz
---FFXT—URES NUMBER MAIN DRAIN
I UNITS I FEES II IUNITSI FEES
Water Heater I I I Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks l I Not Coon.
Dish Washers
Waste Disposals
Wash Trays II STORM DRAINAGE
Washing Machines I Size
Water Softeners ,/ 1 --,U 1I Material
Bar Sinks To Main Drain
Comb. Sink & Trays) To Curb
Dental Units 1-40i
Drinking Fountains) I11
EEL
Floor Drains I WATER SYSTEM
Hoppers I I II Size I I
Restaurant Sinks I II Material I I
Sand Traps I I I TOTAL FEES
Urinals I II Fixture Fee
Area Drains I 1 II Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valvca I I Water Sys. Fee
I Permit Fee
TOTAL I ,SII TOTAL FEE
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final