1513LOT NO.
bio. STREET
FOR PLUMBING PERMI
OF CUPERTINO o i�
1962
Date !?4,Lft 19 ?— Permit No. 3
CIT.Y . OF CUPERTINO F� $ �s
Appllcatlon Is hereby made to the City of Cupertino for a permit to install plumbing
T� 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 Premises
a
Owner Address
gy L d Addre
CONTRACTOR, AGENT
Phone /= 2 S P Approved
LUM ING INSPECTOR
I UNITS I FEES II 1 UNITS I FEES
Water Heater
Water dose,
I Lavatories I 1 II To Existing- I 1_
_llish Washers SEWER BOIC[S
Waste Disposals
Wash Trays STORM DRAINAGE
Washing; Machines Size I I
rain
Ink & trays
Units
Floor Drains
WATER SYSTEM
Hoppers
Size
Restaurant Sinks
Material
Sand Traps
TOTAL FEES
Urinals
Fixture Fee
Area Drains
Water Leaders
Main Drain Fee I�
Storm Drain Fee
Sprinkler Valves
Water Sys. Fee
Permit Fee
TOTAL
TOTAL FEE
RECORD OF INSPECTION
Partial Rough >>
Rough Complete'
Final
3 y
Cupertino Sanitary
. . Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
Sewer Connection Sanitary Permit No.
------------ ............
[!rPlumbing Final Plumbing Permit No.../.3/— -----------
/2 Lot No
Owneror Tenant .......... ... .......... . ... - . ........... ........ --------- -- -----------------------
...........
At .... .........
��o ..... ---- --------- .... .. ------ --------------------------------------- ..................
------ --.- ----------------------------------- - ------------- ------------------------------
Tract -----------
------------------------------- -------------------------- 190;-7
Date Connected .... --------------- --------- - .
Date Final ...... --------------- ------- -------- ---------
19
----------- .. IM..B..I.N. G- INSPIrCTOR--
------------------------
111 1160-500