51099.1 (2) a,)7,P3 ✓ enc al' LOT NO,
NO. STREET
® f46�� 10 LFD
R PLUMBING PERMIT
Qi z CUPF.RTINO
ro IMAY 27 1968 Sanitar}, iN�o.
oDate — Permit No S/0 99/
3 `
a 0 .CI 0 CUPER 1 I�1.J Fee S •��r•5 6
° Appbc.tion is hereby ma e o he i of Cupertino for a permit to install plumbing
, 1- pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r r 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 x��
00 /� �— q
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Owner
//.P�.JI2C/-/���� (,6�-x.ctf:�� Address ��j•� bx-C JfCy/�Ge eeC�
z By �: O� SCLC a Address 10;f
O OMR ;Dp AGENT'
— m Phone
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a
a o State License ApprovPolfILLIAM D. BENEVICH
U \ PLUMBING INSPECTOR /
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Y .3,00 Size r�
Water Closets ,00 Material Q, �
Bath Tubs y 3,001 To Cur
Showers L 3,00 1 To Prop. Line
Lavatories ( .0 O To Existing
Kitchen Sinks y 3,00 Not Conn.
Dish Washers S wer Boxes
Waste Disposals
Cash Trays STORM DRAINAGE
Was ing Machines y 3,00 Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sinks Trays To Curb
Dental Units
Drin ing Fountains
Floor Drains WATER SYSTEM
Hoppers Size / ' 40
Restaurant Sinks Material 6,q(V.
an raps TOTAL FEES
rinals I Fixture Fee a2 .0 0
rea rains Main Drain Fee '00
gate, Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee j.50
Permit Fee Z,Oo
TOTAL TOTAL FEE —3k-70--
RECORD
k0RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final