4049 /a�/ �� .I.l-���. § _ ✓ `i ✓" i�`�-- LOT NO. ..
((rj j► � -i1TdgNi`FOR PLUMBING PERMIT
ma I� i i
C OF CUPERTINO
f p APR 21 1964 d
Y o Sanitary No.
o a Date 196_ Permit No
W CITY OF CUPERT*^'r: Fee $ a�J
W_ W
� 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
i m and/or fixtures in accordance, with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applic le thereto.
w x
0 w Use of Premises
00
o < Owner �/J X— Lr Address/G 5`73 ��//—,..�
� a�By 441 ✓� Address I cf7 3/ C�li+�n.., 4!t 4(
3 o CONTRACTOR,AGENT
— m Phone
w w
a o tate License 2—I Approve
-U � PLUMBING INSPE
FIX I URESil BER MAIN DRAIN
UNITS FEES UNITS1 FEES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
La;;atories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
erste Disposals
Was-Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sinks Trays To Curb
Dental Units
Drinking Fountains
�-
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
eater Leaders Storm Drain Fee
Sprinkler ValvesWater Sys. Fee
Permit Fee
TOTAL TOTAL FEE cL
RECORD OFINSP
Underground Rough...
PartiSl Rough..
Rough. Complete..
\Wain Drain e
Fi ...