51125 COT NO
.•.} NO. T
CION FOR PLUMBING PERMIT
z < C OF CUPERTINO
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r o A Sanitary No.
0 a Date 7 6 Permit No
3u �; �/ Fee
, 0 Ap�fic�tioOlk he he City of Cupertino for a permit tinsta I plumbing
0 W pipes and/or fixtures sQreverse side hereof, and agrees to install said prices
a and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
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Cupertino, and all other laws applicable thereto.
g �. Use of Premises
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3 Owner— Address 119,7 J�e9-
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O CONTAACTO , AGENT
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ao State Lice ns Ia?d Approved k/•
—U PLUMBING INSPECTOR V/
NWN, BER MAIN DRAIN
qL UNITS FEES UNITS FEES
INHeate Size
Wa "r Closets Material
Bath Tubs To Cur
Showers To Prop. Line
Lavatories To Existing
Kitchen Sin Not Conn.
Dish Washers Sewer Boxes
Waste Disposa s
as Trays STORM DRAINAGE
Was in—Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sin c—Trays To Curb
Dental Units
Drin— in—Fountains
I' oor Drams WATER SYSTEM
uppers Size
Restaurant Sinks Material
San raps TOTAL FEES
nna s Fixture Fee
rea Drains Main Drain Fee
Water Storm Drain Fee
Sprinkler ValvesWater Sys. Fee
Permit Fee o
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough.. -
Rough Complete-
Main Drain
Final...