1202 (3) a A�� -
LOT NO.
/0 .
NO. ST EET
FOR PLUMBING PERMIT
OF CUPERTINO
MAUG 3 0 1961
Date - 1.95_ Permit No. /,:;?/O
CITY OF CUPERTINO Fee $ (: � o 00
Application is hereby made to the City 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 prod ' s of the Plumbing Code of the City of
Cupertino, and all other law pplicabl ereto.
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2' Use of Premise
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Owner -p- - bLB�v��c c r'dress cd ✓L'
By /7// G.1` Address
CONTjtA�TOR AGENT pp
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PLUMBING INSPECTOR
—P•IXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater ( I Size
Water Closets Material '
Bath Tubs To Curb'
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
.Dish Washers
'Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material I I
Bar Sinks To Main Drain
Comb. Sink a Trays To Curb
Dental Units �� -
Drinking Fountains � II
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals �. Fixture Fee
Area Dra.ns1 111 Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Vawes I Water Sys. Fee
ZE'VER13
OxE9 Permit Fee
TOTAL TOTAL SEE
RECORD OF INSPECTION
Partial Rough
Rough.Co tete
Final
.,-,,, .-_,CERTIF.ICATE ' OF COMPLETION-, r
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`BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
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Owned by. �/
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hr BuJdrng Locate at / •+1� U"� ., .t� ��°!/ •�/'! `)•
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