51234 10099 So. Blaney LOT NO. 1
NO. STREET' p
CRY Of CUPERTINOCITY OF CUPERTINO O A UN 1T S
w = JUN 8 197,p 1 PPLICATION FOR PLUMBING PERMIT
r o Sanitary No.
0 4 R A 14V24/71
O -' D e , 19 _ Permit No
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wLL Fee $ J
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� Application is hereby made to the Cit}' 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
1 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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Use of Premises Apartments
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3 Owner----Jerome White Address 10159 So- Blaney
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j , By San Jose Mechanical, Inc. Address 1665 Rogers. Avenue,
n CONTRACTOR, AGENT ,
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< Phone 275-9044
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<boy Stare License 2f�t285 Approved • /
Id- F PLUMBING INSPECTOR
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FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater 1 Iii Size tk" 5°--
Water Closet 8 w°% Material cI
Bath Tub g Iti°% To Curb
Shower To Prop. Line
Lavatories 8 m'°, To Existing
Kitchen Sink S 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 I "
Restaurant Sink Material G+w/
Sand Trap TOTAL FEES
Urinal Fixture Fee t{q SO
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee I S$
Re]pef Valye 11 Gas Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee 2.�
Total Total Fee