51089.1 (2) dy 2120 I West homestead Rd. Bldg. #2
LOT NO.
NO. 1 S A
r CM. F 'tPLUMBING PERMIT
CITYICUPERTINO
x o /MAY 31 1968 d ' Sanitary No.
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o a [)ate 196_ Permit No
3 U ..II iY Ur CUPERTINO Fee $��.e2. .s�
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o Application is hereby made to the City of Cupertino for a permit to install plumbing
o r pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
I and/or fixtures in accordance with the provisions of the Plumbing Code of the City Of
a w Cupertino, and all other laws applicable thereto.
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LL Use of Premises aDartmerit
00 bOl American St .
3 Owner Herman Christensen Address San Carins
�j 2301 Palm Ave.
� z By .T_ W. 1$r(;l annhan (;.. Address ,-,
CONT CTOR. AGENT
a 345-1691
— m Phone WILLi".'1 D. BENEVICH
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u s State License 1331 Approved
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_U PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEESUNITS FEES
Water Heater 3 - .>o Size /
Water Closet /6 — Material y�i1
Bath Tub / 4,9— To Curb
Shower To Prop. Line ✓
Lavatories I6 a1 — To Existing
Kitchen Sink /6sgri�r Not Conn.
Dish Washer / ,7 Sewer Box
Waste Disposal I6
Wash Tray STORM DRAINAGE
Washing Machine j ,SO Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink 11 Material jp
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee .0 0
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee 2' .66
Vac Breaker _
Skimmer
Filter
,//,OO Permit Fee �•0U
Total /g Total Fee o2a• %