51130 Lor No.
NO. TR
It OR PLUMBING PERMIT
� < D
z i p OP CUPF.RTINO
' 0 %TJUL 12 1965 Sanitary No.
o a Date 96_ Permit No 1�5_1/ a O
w o CITY OF CUPERTINO Pee $(
—
Application is hereby made to the City Of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse 'Side hereof, and agrees to install said prices
is and/or fixtures in actor nce with the .visions of the Plumbing Cod of the City of
a w Cupertino, and all �th J",s a -lic- le ereto. s
w i
� r
a Use of Premi
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o a Owner Address
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J , B, Address*3u
CONTRACTOR, AGENT
3 Phone 2 i3 -a-y 6 I
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a o
State License 7u 760 ` Approve ev"
— U AL PLUMBING INSPECTOR
HX I URLSNUMBER
UNITS FEES UNITS FEES
`X/a[cr Hcam 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
Water Softeners Material
Bar Sinks To Main Drain
m c
Co . Sin s 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
IVater Leaders Storm Drain Fee
sprinkler voles Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final