1374 •J ��A'II �� /��/..%C�' LOT NO.
P JC TIONT FOR PLUMBING PERMIT •/ • . )
y CITY, OF CUPERTINO
J
Date + p� 19� Permit No.—,3,/X
IA J� - Fee$ `"Y•
Application is hereby made to the City of Cupertino for a permit to install plumbing
l pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
.a r
� OZA � Address
4
ByAddress
Phone
ACTOR, AGENT �-
_ Approve
/ PLUMBING INSPECTOR
^tA C--Z. L Z�
:FIXTURES '•NUMB_ " MrA1N DRAIN
!-I UNIT91,11 FRS1111W '';' � UNITS FEES'
''Waver IMFte-r,1._..;'- I:.; tW&ARHM Siie
'Water''Closefs ,.' j&,,bMj .j�'Aaterial j-
Sath'dTr u,=A f 500jl To CurbAp 1 j
Sh"ow_ I W1511&q Prop. Lihe I j
'L17atocie , , j_ `Ilr ®I To Existing, I j
[Cit n . ' 1I1�aot Corin T/,
Waste DijMss 'ts ' I
STORM,jL)RAINAGE j
Washing Machin J! . I .Sizc
,Water Softeners j Material
Bar Sinks - _ j To Main Drain j
.C•omb Sinkll&iTrays �'aI�' II To Curb
I
:'Dental Units - "°`x j "U" 11 _
FDtinking Fountainsl A,j " , jl
(Floor Drains. tI 7I JM II WATER SYSTEM
Hoppers I I:I ® II Size I_
Restaurant Sinks j Material j
Sand Traps 15 tti�jr m jI TOTAL FEES
Urinals 11§ 7 Ik W 11 Fixture Fee
Area Drains jR� ". ' �j Main Drain Fee It a
Water Leaders j j jj Storm Drain Fee
Sprinkler Vane: jg__ j .jj Water Sys. Fee j
Permit Fee J. 0
(TOTAL ' �j� TOTAL FEE
1 KR;ECORD OF INSPECTION
Partial Rough
Rough C4pl to Y,
Final
-upert)'no Sanitary
,nffice�Copy
BUILDING INSPECTOR'S OF
- CITY OF CUPERTINO
..T. � •�x: . wc5 r ...
❑ Sewer Connection r� Sanitary Permit No .................
kimbin' Final - Plumbing Permit No'1"' � '
IU
LotrNo. ... .......... -----:......
Owner or Tenant -7%� t
r .2. - . '
/,yr� .......... ....
At ..!"'G�--. ��—n �� (�/3�I11 ---..... a -...._. �.'.-"'i-..'YI%rr'w4r•:
... ..............................................
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/ .
Tract
Date Connected -----------
onnected -------r--...--`-`----l/`-----------.._...._--------------- ._ ....v
/
Date Final ................................./,/.............. .... "< 1 ....,..... i
t
INSPEcrOR
I l 1/(,0500 (/PLIiMI3ING
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