51039 /vj*Z1 I ( W
, LOT NO.
J CTCAr10 FOR PLUMBING PERMIT
W z It s'—�(� I Y"1: CUPERTINO
s r �' Sxnitar A'u.
E 19 1966 // Y o
o Date �[96h Permit No
3 `
u
w LL � 'r� Pee $
Mk
O ApyQf ibn orr".XI[RE''R �� it), of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on�h-e"'raerse side hereof, and agrees to install said prices
i m and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all otl laws applica veto.
wi a
.. *qerruses
003 0 <zAddressl—elON A TOR, AGENTo
< � � � s`
a o, �1i1te Licend 7�� Approvedl�'�/�� /
—u �rj— PLUMBING INSPECTOR �C�
FIXTURES
UNITS FEES UNITS FEES
'mater Heate Size
Water Closets Material
Hath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Was-Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units
Drib 'ing Fountains
�Kloor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES v
Urinals Fixture Fee
Area Drains Main Drain Fee
Nater Leaders Storm Drain Fee
5prtr,klcr 71. Water Sys. Fee /, 00
Permit Fee p
TOTAL TOTALFEE
RE ORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
\lain Drain
Final