100074 LOT NO.
N
?VJQ&A1 J FOR PLUMBING PERMIT
a Y OF�CUPkiRTINO
x oF.E 21 1966 sanitary No. � ��� gam/
3 < Date 196 Permit No. �0 � T
LLC T�� OF CUPERTINO Pee =
O 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
> 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
� r
�. Use of Premises
00
7 N
o a
Ownerk,--,./, - CLd Address �DC�K4
o Byd�rre-z �irr✓S Addres
— m Phone / V
o s 'state License Approved
a O I i
U PLUMBING INSPECTOR
FIXTURES a
UNITS FEES UNITS FEES
Water Heate Size
Ware, 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
Com . Sink a 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 J
ZVater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee C;L
TO-TAL1 TOTAL FEE Oro
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final