683 / 0.2. / I Lor rvo..
NO. STREET
ION FOR PLUMBING PERMIT
C OF CUPERTINO 10
V41AR Date5_ Permit NO. b 4
\ - �pT ^'(� Fee $___!—�
Apo{cTt� ia5R �RQn 0Fer ity of Cupertino for a permit to install plumbing
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 la s applicable thereto.
Use of Premises
a
Ownet �124K'��aAddress
BY1Il� �'� ,"��/�v' _ AddressO/7�Ghp
CONTRACTOR, AGENT .S
Phone_"'Z 3 'e'zz/ Approved
PLUMBING INSPECTOR
TIXTURES NUMBER MAIN DRAIN
UNITS FEFS UNITSI FEES
Water.:4catcr 11 Size
Water Closets 1 r Material I
Bath Tubs To Curb I
ShowersL,z _ To Prop. Line
Lavatories I II To Existing I.
Kitchen Sinks " Conn.? si ✓' VV ^
Dish Washers - IISEWER BO ES I l
Waste Disposals _ II
Wa h ;Trays STORM DRAINAGE
Wasbing.Machines Size _
Water Softeners Material-
Bar Sinks To Main Drain
Comb. Sink &Trayi To Curb
Dental Units _.
Dunking Fountains) li
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee .U
Area Drains I I II Main Drain Fee CC)
Water Leaders Storm Drain Fee
Sprinkler Va Wes I I II Water Sys. Fee I 0
JI Permit Fee a G
TOTAL. 11 TOTAL FEE
RECORD OF INSPECTION
Partial Rough
An�
Rough l'om
Final
� ar
v Cuper6nc•S40ary
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
Sewer Connection Sanitary Permit No. ......//.;.o .......
[Plumbing Final Plumbing Permit No. .....1 .
K
/ � ctca� . / �G�..
. ........ ........--
Owner or Tenant ...(�;�_..��'�'�[/.. - -- � .... .... .... . ., ..._--....
At
,g� o
Tract .......df Cl ----------
--
Date Connected ..--------------------i.% - - ....... - ...... ... - -- .... 19..
DateFinal .......---__.........:...t ------------ ......................... ----------------- 19.40—
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Ill 500
•ti 1I31NG INSPECTOR