51009 3 LOT NO.
NO. sTRE
APPLI ATION FOR PLUMBING PERMIT
a CITY OF CUPERTINO
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r o Sanitary No.
o
,1964
3 Date 196— Permit Nam o v
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W Fee $
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I O
� Application is hereby, made to the City of Cupertino for a permit to install plumbing
o a 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
<w Cupertino, and all other laws applicable thereto.
0 Use of Premises
00 ..
r 3 Owner WPI N218on r:i;::_r r cG. It;C_,ddress 10366 Wolfe Rd., Cupertino
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J z By Collishaw Sprinkler Co.Inc. Address 1515 Walsh Ave. . Santa
O CONTRACTOR, AGENT
3 < Clara
— Phone 296-9075
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ww
a o 27
State License—24980 in Approved
U PLUMBING INSPECTOR
FIXTURES
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks NotConn.
Dish Washers Sewer Boxes
Waste Disposals
as'h Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink & Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER.SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee 30
rea Drains ` ,yd Main Drain Fee
Water Leaders j,� Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee ' ,�
TOTAL ?J TOTAL FEE
RECORD OF INSPECTION
_Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final...