NO PERMIT NUMBER /DI/ / I N• I oralem LOT NO.
N STREF.I'
APPLICATION FOR PLUMBING PERMIT
z d CIT CLTaTINO
xo P o an : ' No.
3 U Date �/ Eb9 1 4 968nit No
$ o2C� 6 0
W LL
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� Application is hereby, made to the City of Cupertino for a permit to install plumbing
`o pipes and/or fixtures listedlvnIthe-M,erlvel �g-¢�r� I d agrees to install said rices
> r and/or fixtures :n accordance with-the prma3ldns`(df�1 lumbing Code of the City of
<w Cupertino, and all other laws applicable thereto.
,. Use of Premises eR&c -
0 0 //pp ,�,
3 Owner, D A Li
Addrress�dlO yO,S S-tj E
3 0 ljy CONTRACTOR,AGENT bZb UllarlOAt
— W Phone�`'Ds.S� San Jose, California 95112
wz
0 a �ls-32 Approved
a o Stale License ,
11 -V PLUMBING INSPECTOR
AII)FIXTURES NUMBER MAIN DRAIN
I1NIT5 FEES UNITS FEES
Water Heater Size /;, I .po
Water Closet 11 Material �•
Bath Tub o To Curb
ShowerA50
Prop. Line
Lavatories ,COGYM To Existing
Kitchen 5ink ,Sp Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine .Sp Size
Water Softener Material
Bar Sink To Main Dm n
Comb.Sink&Tray urb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Materizl� ✓
Sand Trap TOTAL FEES
Urinal Fixture Feed
Area Drain Main Drain Fee ,bpd
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee Q
Vac Breaker
Skimmer
Filter
Permit Fee pU
Total Total Fee (,jj