51089.1 (7) dh 21230 West Homestead Rd. LOT NO, n rl 7
NO. STREET
NaT�O�V `R PLUMBING PERMIT
d rqX �CUPERTINO
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r o MAY 1 1968 sanitary No.
o a Date 5-24-6 1 6._ Permit No
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QTY L;r, C�,J� RI Pee $ 'f9 as
Application is hereb}' I ad to IP 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
> a and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
wCupertino, and all other laws applicable thereto.
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� 4 Use of PremisesfiAffrt!flents
00 801 American St .
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3 Owner Herman Chri sten CPn Address Cor
°-1 2301 Palm Ave.
B J. W. McClenahan Co. Address qor
J C NTAACTOR, AGENT
3 < 34�-1691
z Phone WILLIAM D. BENEVICH
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State License 133158 Approved
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- 0 V, PLUMBING INSPECTOR 1/
[I
FIXTURESIUMBWFxisting
IN
NITS FEES
Water heater Water Closet Bath Tub Shower Lavatories
Kitchen Sink 5" - Not Conn.
Dish Washer Sewer Box
Waste Disposal _s
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 z 3.0o WATER SYSTEM
Hopper Size
Restaurant Sink Material 9 e
Sand'ITrap TO'T'AL, FEE
Urinal Fixture Fee -o
Area Drain Main Drain Fee S,V0
Water Leader. Storm Drain Fee
Sprinkler Valve Water Sys.Fee i.j c
Relief Valve Cas Fee Sa
Vac Breaker
Skimmer
Filter
,c7 Permit Fee
Total ;* t-7b Total Fee