51143 (3) 22�a0 I Voss Avenue LOT NO.
NO. STREETrr'
ICr FOR PLUMBING PERMIT #7365
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CIP CUPERTINO
o Sani[ary Nu.
0 DatePYa5l7 1967 7 Permit No S//py�3
U Pee $ ��0• `S O
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LL ° AM � OF t!'�Y.Y�`I I�GIY 7 P P .� plumbing
A i t n s er it of Cupertino fora permit to install lumbin
o a pipes and/or fixtures isted on the reverse side hereof, and agrees to install said prices
> 1- 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.
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Use of Premises Convalescent Center
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r3Owner T-) A_ Excell & Assoc Address P O. Box 508
°_ Los Altos, Calif
J o By W. T.. T3;cke ons Inc. Address 198 Commercial St,
3 F coNTRA TOR, AGENT Sunnyvale, Calif 94086
— M`, Phone 736 4938
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a o State License 95122 Approved_
UI PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN —1
UNITS FEES UNITS FEES
Water Heate JL- '30b SiZe k, S,['O
Fater Closets f r yr 73.51) Material C.o }
Bath Tubs ,Sr 3L1, 5-6 To Curb
Showers J,5o /o ay To Prop. Line'
Lavatories t,Se SO 7.5-CD
To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
\r!/as'h Trays ,Se ,V STORM DRAINAGE
Washing Machines Size
Water Softeners Material ^—
bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units as• (,$a
Drinking Foun ains
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rains yo WATER SYSTEM
s r.° '�- Size nt Sin[s Material Gaj.
raps TOTAL FEES 8 er-
Fixture Feerains Main Drain Fees.[oo
eadersr v,IvesWater Sys. Fee"w -J- 3OD Permit Fee��50 TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final