51145 100-AVP/W/1 G' - LOT NO.
NO. STREET
TIMI FOR PLUMBING PERMIT ?�J
1 OF CUPPRTINO
0 IFEB 18 1966 s""i"'rY '�" '/
a Date 196— Permit No J/—/ �
U Pee 5 '.'rfW
= LL G4TY A Ul,IPTE�WINO
City° A I a io he I City of Cupertino for a permit l0 install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
I 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.
w x
W Use of Premises sT.f Z.Lf/l?.
0 0
w .�'� �i4A
r 3 Owner Address
oa
J
, By v Address
3 O CON RACTO AGENT
N
Phone � 5 q- cis- Ci._,e
W Z
y07
a o State License z?o Approved
U PLUMBING INSPECTOR
1AX I URES
UNITS FEES UNITS FEES
Water Heate 00 Size
Water Closets y o Material �y
bath Tubs To Curb
Showers To Prop. Line
Lavatories j To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines d Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink x Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size /
Restaurant Sinks Material Ad
San Traps TOTAL FEES
Urinals Fixture Fee ,00
Area Drains Main Drain Fee , 00
VX ater Leaders Storm Drain Fee
Sprinkler Volvos WaterSys. Fee Ov
Permit Fee , Q'O
TOTAL 14e,, TOTAL FEE , OV
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough Complete
%'Iain Drain
Final