51064 LOT NO.
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® 1� I •� FOR PLUMBING PERMIT
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OF CUPERTINO
x pX /AUG 2 3 1965 111�.111��111�I����
/ Sanitary No.
0 i Date 196 Permit No .S /d
w CITY OF CUPERTINO Fee 5 i
x LL
o Application is hereby made to the City of Cupertino for a permit to JF
install plumbing
0 a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r 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.
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Use of Premises 1.L."Cx- -. t
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OwnerL a'-� " Address ��•rs �� t1, /'
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z By. c�C�V{:l-J .. J IM1- vv-Address��.-� l - t,wt"�Z• LCC 'L
O CONTAAC AT
— z Phone
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u f State License-- C G '�C% Approved ��
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—U PLUMBING INSPECTOR
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HXTURES M
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
hath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
KitShen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
,Water Softeners Material
Bar Sinks — -To Main Drain
Com . Sinks Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
bVater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee f�
Permit Fee
TOTAL j j00 TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final