51009 (2) /O 3,�-o I - LOT NO.
NO. STR
CAI FOR PLUMBING PERMIT
< �i1 C OI' CUPERTINO
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x ° EP 1 965 Sanitary \'o.
VSJJ 1 /Oo
o Date 196_ Permit No,
3 `
_ ° Al a on her U �C PeeS 71
LL �1T Q GPRER1IMdk
1 dy ofCupertino for a permit to 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.
a LL Use of Premises _ Res.
00
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0 3 Owner t1 E S Address
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J z By -B 1.1 2I �aa Address6r45 T Yf-PIA li
3 q CONTRAC OR. AGENT 111/• ('114"4/
— 0 Phone
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a PP
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State License 4 � Approved
"/' PLUMBING INSPECTOR /
FIX I URES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
'Plater Heme SizC �
Water C osets Material
bath Tubs To Curb
Showers To Prop. me
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposa s
as'h Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant SinksMaterial p(
San Traps TOTAL FEES
Urinals Fixture Fee QQ
rea rains Main Drain Fee
Water Leaders Storm Drain Fee
Jprinkler Vatvcs Water Sys. Fee
Permit Fee ._
FF—
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Alain Drain
Final