NO PERMIT NUMBER ►9q ► 1 LOT NO. �o
NO. Si TR E FT
APPLICATION FOR PLUMBING PERMIT
" < CITY OF CUPE.RTINO
rSanitary No.
Q 0 p'
O j Date 196Y Permit No
U
3 Pee 502 S—v—
2 LL
� ° Application is hereby made to the City of Cupertino for a permit to install plumbing
`o pipes and/or fixtures listed on the reverse sid >f, g es to install said prices
> and/or fixtures in accordance with t PI mb n ode of the City of
a w Cupertino, and all other laws appli i b o.
Use of Premises ' (SEP 19 1968
00 A
3 Owner�J_r_ d�sp
ZJ I { • l�U I
o By (,mtLea� QADe, KR
3 H CGNTRACTGR, AGENT 625 Charles Street
W 0 Phone�U OSy� Sanose; California 95172
0 s State License.) 7,1632 Approved
a o
�� -U 'A PLUMBING INSPECTOR v
&JFIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size q"
Water Closet Q Material d•
Bath Tub To Curb
Shower „$JJ To Prep. Line ef
Lavatories .SD To Existing
Kitchen Sink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main
Comb.Sink&Tray To
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size v I
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee Z-5 1091)
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water S s.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee U
Total Jr.QQ Total Fee