51234 20030 I Rodrigues LOT NO: 7
NO. STRE F.a'
Gly Op CUPERnmo CITY OF CUPERTINO
" < APPLICATION FOR PLUMBING_ PERMIT g D S
zy JUN 8 1971 Sanitary No.
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3u1)atP I _y 2h, 19 1�1 Permit No.
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O Application is hereby made to the City of Cupertino for a permit to install plumbing
o apipes 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 ❑11 other laws applicable thereto.
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Use of Premises Apartments
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3 Owner Jame Mite Address 10159 So. Blaney
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J , By San Jose Mechanical, Inc, Add,ess1665 Rogers Ave, S.J.
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3: i: CONTRACTOR, AGENT
— 0 Phone 275-90h1L
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aa State License 264285 Approved J(/
— U PLUMBING INSPECTOR / 1
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FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater / Size y
Water Closet 30 ,.o Material r
Bath Tub /.2 /P.od To Curb
Shower f /a.00 To Prop. Line
Lavatories, .20 30.ei To Existinw.
Kitchen in /y /%.eD Not Conn.
Dish Washer
Waste Disposal
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 SYSTEM
Hopper Size L:
"
Restaurant Sink Material Goer
Sand Trap TOTAL FEES
Urinal Fixture Fee e
Area Drain LMam Drain Fee Sie
Water Leader LStom Drain Fee
Sprinkler System Water Sys.Fee /.,To
Refief Valve 11 Caq Fee /.JO
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee 1.0
Total JO Total Fee /