51135 �o30s L./TN7'/l� ^N LOT NO.
NO. !T EE.a'
® ?P10 N FOR PLUMBING PERMIT
TYOF CUPGRTINO
wio ��CT 13 � Sanitary Nu.
0aDi1965C Permit No3 S
Pee $
0 vIT�pp� ior1"Yhe 'tfi'aH!'to the City of Cupertino for a permit to install plumbing
`o < pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
n Use of Premises
00
53 Owner /1��� � • ofr Address
_= B HAYNL FT WATER SERUICF�ddress
o y ..
3 a SANTA CLARA, CALIFORNIA
— w Phone PNnNF. 9n1a99n
0 2 State License Approved
141XTURES UM ER MAIN DRAIN
UNITS FEES UNITS FEES
Water Henrcr 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
\later Softeners gL.ac Material
Bar Sinks To Main Drain
Comb. Sink % Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM;
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
�prinkler Vawes Water Sys. Fee
Permit Fee
TOTAL y[�o TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
.Partial Rough..
.Rough. Complete..
\lain Drain
Final...