51037 LOT NO.
NO.
ST.F
AP LtC 'T N FOR PLUMBING PERMIT
< ��ITN' OF CUPERTINO
raOCT 2 9 1965 _ sanitary- No.4
o J Date 196 Permit No
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CITY Pee S � U
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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
a w Cupertino, and a ier laws applicabl thereto.
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Use of Premises
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Owner
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J z B Addres
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3 r CONTA OR,AGENT
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a Slate LicensQ /1,L y Approved
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PLUMBING INSPECTOR, /
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FIXTURES NJBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heat. Size
Water Close's Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.'
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units -
Drinking Fountains AML
floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Arrt Drains Main Drain Fee
VIVater Leaders Storm Drain Fee
$pinller valves Water Sys. -Fee O
Permit Fee • G O
TOTAL TOTAL FEE * 00
RECORD OF INSPECTION
Underground Rough 1
Partial Rough
Rough. Complete
Main Drain
Final