51089.1 (4) 21230 West Homestead LOT NO Bldg. #L.
NO. STREET
gpPllCTO�FO,� PLUMBING PERMIT
< ✓! �'rfT-,;O .EIPERTINO
Z Z
Sxnitar No.
f Y 31 1968 i1 y
o Date 5— f� 196_- Permit No 5
3a
w LL ITV //fi�r Cn Pee $ oZ9 a�
o Application ishereby mad ;�kc"y„bf Cupertino for a permit to install plumbing
o 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
a w Cupertino, and all other laws applicable thereto.
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�. Use of Premises apartments
00 b01 American St .
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0 3 Owner Hemman Chri ai-pnean Address San CAnI nc
°j 2301 Palm Ave.
Jz p J. W. McClS _.._
enahan Co . AddressF
J 0 y CONTRACTOR, AGENT
3
0 Phone 345-1691
—
w z WILLIAM D. BENEVICH
u f State License 133158 Approved
a o
PLUMBING INSPECTOR
(" v 1
FIXTURES NUMBER MAIN DRAIN
UNrrS I FEES UNITS FEES
Water Beater / %.>o Size Y' —
Water Closet `/ (o _ Material M
Bath Tub 4 — To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen Sink y' Not Conn.
Dish Washer b Sewer Box
Waste Disposal H
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTE67
Hopper Size Icy 1 / i 1,>0
Restaurant Sink Material ,9
Sand Trap TOTAL FEES ,.Sa
Urinal Fixture Fee
Area Drain Main Drain Fee "-CA
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee i ,j p
Vac Breaker
Skimmer
Filter
,S—e Permit Fee .00
Total Total Fee o29.5