51126 (2) • �QG � y.�..-'• v ` LOT NO.
/ NO. T!(EE.T
C N FOR PLUMBING PERMIT
�.ITY OI' CUPERTINO
z � ft.1 Ij��
x o P 21 Sanitary NO.
LL
o Date — 1961-5Permit No
3a
UPee $
i � F
° CT�A 'li�tion iiss�" recy ma'N' to the City of Cupertino for a permit to install plumbing
'o a 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
<w Cupertino, and all r Taws applicable thereto.
w t O
W Use of Premises
00
0111-1
3 OwnerA dyes
D
z By
ONTRACT A ENT
3F �F3 _
- 0
Pho
W Z
oState Licen Approved
�. PLUMBING INSPECCOR /
v
FIX I uRhsJ
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen 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 . Sink u Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San7 Traps TOTAL FEES
Urinals Fixture Fee A 190
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
A
Permit Fee 2 100
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final