51064 /0 /// t/ &= LOT NO.
fAPfA
No SREET
%a. ON FOR PLUMBING PERMIT
R 2 6`.196 CITY OF CUPERTINO
t 1 25 195-i6 Permit No.
01 OI UPERTINO Fee $ I. 00
Application is hereby made to the City of Cupertino for a permit to install.plumbing
� pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
10 and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
o Cupertino, and all other laws applicable thereto.
&' Use of Premises
v
Owner H. W. Nininger Address 10111 Phar Lap Dr_
By Ra Water SepViC991k Address 243-B Moffett Blvd
/ OF7_L545 _ Approve Gc/ l
Phone �
N" PLUMBING INSPECTOR
---rTXTURES NUMBER MAIN DRAIN
UNITS FEES UNITSFEES
Water Heater II Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines II, Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink & Trays III To Curb
Dental Units I I Ii
Drinking Fountains) II
Floor Drains I 1II WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee w+
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves I Water Sys. Fee T�
Permit Fee s 4.0
TOTAL TOTAL FEE fe i
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final