51177.1 (2)io71 ST/,—es ,-�i,e--
LOT
NO. STR F. F.I'
jONICATI
i
z
W � T)h
CITY
w p
E
YO o O
rc
FOR PLUMBING PERMIT
OF CUPhRTINO
Sanitary No.
° '1 8/j0 196_ Permit No 3%/ 77 i
3a
i w Pee $
-A.1b0 —
,0 PPbWi0 to the City of Cupertino for a Permit to install plumbing
o a CV13S :�ui�'/orl6 r�YV� 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 all other laws applicable thereto.
wx
J
00
_
J N
03
oa
ZJ
Use of Premises Residence
Owner
W Iter J. Jakobs
By SOFTMASTER, INC,
° CONTRACTOR, AGENT
3�
—0 Phone 3 % %—Sa SO
Address10700 Stokes Ave
Address 1150 Dell AVe.
Campbell, C . 95008
w Z
w w
a o State License —222` do/ Approved
— U� PLUMBING INSPECTOR
FIXTURES
M
UNITS FEES UNITS FEES
Water Heate
Size
Water Closets
Material
bath Tubs
To Curb
Showers .
To Prop. Line
Lavatories
To Existing
Kitchen Sinks
V,Not Conn.
Dish Washers
Sewer Boxes
Waste Disposals
Wash Trays
Washing Machines
STORM DRAINAGE
rI Size
Water Softeners,
Material
bar Sinks 0
To Main Drain
ComIT Sink v Trays
To Curb
Dental Units '
Drinking Fountains
Floor Drains
WATER SYSTEM
Hoppers
Size
Restaurant Sinks
Material
Sand Traps
TOTAL FEES
Urinals
Fixture Fee
Area Drains
Main Drain Fee
]
`Rater Leaders
Storm Drain Fee
Jprinkler Valves
Water Sys. Fee 7sw3w—
Permit Fee a o v
TOTAL
TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
\Iain Drain
Final