2741 LOT NO.
NO 0 EF. '
P O OR PLUMBING PERMIT
i ii D I P CUPERTINO
r o MAY 211964' sanitary No.
3 � 2
0 Date U *CUP Permit No
3 a IVU
U Pee $�.00
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0 Application is hereby made to the City of Cupertino for a permit to install plumbing
o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> r 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 Residential
00
3 Owner Ruth Starbeck Address 10440 Pineville Avenue
Oa
JZ Lindsay Soft Water Service
JZ By Y Address 351 Meridian Road
3r San Jose, Calif.
— 0 Phone 292-8497
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s State License 212096 Approved � ,
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-t) CONTRACTOR, AGENT
FIXTURES NUM s IN DRAIN
UNITS FEES UNITS FEES
awr Heater Size
Water Closets �Materal
Hath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
WV
ashing Machines Size
'Water Softeners Material
IBar Sinks To Main Drain
Comb. Sink c Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
—Sit-77—raps TOTAL FEES
Urinals Fixture Fee 1.00
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler valves Water Sys. Fee 1.00
Permit Fee 2.00
TOTAL 1 4.0011 TOTAL FEE .00
RECORD OF INSPECTION
Underground Rough...
.Partial Rough..
.Rough. Complete..
V'Iain Drain %