5100238
NO. LOT NO.
No.
PLUMBING PERMIT
/SEP 9 19Y►'UPERTINO �� 3
6G0' Sanitary No.
Date S `� ERTI - Permit No
�
Pee 9 O G 3
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 provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premiises,�
Ownee�r��/�/ e" w t
By gym•
CONTRACTOR, AGENT
Phone
State License "%6—� 317
Address,2934"
/,os yin jj
Addressly2S e40 5
WILLIP44 U. L-_NEvlr;jj
Approved /
Y PLUMBING INSPECTOR V
FIXTURES NUMBER MAIN DRAIN
TS 1 FEES UNITS FEES
Water UNI
leater 3.001ilisize 1500
Water Closet 41 1 2.60 11 Material
Kitchen ink
Dish Washer
Waste Dispa
Washing Machine
7"o,011 Size
Water Softener
Material
Bar Sink
To Main m
Comb.Sihk&,Trayurb
Dental Unit
I Drinking Fountain
Ij Floor Drain
WATER SYSTEM
,hopper
Size/a
Restaurant Sink
Material (pA.4-
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
y�
Area Drain
Main Drain Fee ,S
00
Water Leader
Storm Drain Fee
Sprinkler Valve
I I I Water Svs. Fee I
Vac Breaker
Skimmer
Filter
Permit Fee O�
Tota] .o I Total Fee