NO PERMIT NUMBER LOT NO.
NO. F.l'�
AP �A�10101`,OR PLUMBING PERMIT #I vo
N �'� S-1
(�IT IOP CUPERTINO
f I( OV 24 1957 sanitary No.
Y 3 OaLL
Date dig1_9�
6� Permit No
Pe
Fee if C �nEpT
O
Application is hereby made to the City of Cupertino for a permit to install plumbing
o < pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r 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 M
a Use of Premises
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a Owner QJi CO�if icP ...,li Addres,1.8,�f 2,Y P &Qk
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z By � ot. �dLf'Xoii, �ed�,�• Address
O CONTRA - A, AGENT T
3 `m Phone
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a 9 �i a a.
a o State License Approved
_U It/�, PLUMBING INSPECTOR
I,IX R . NUMBER
UNITS FEES UNITS .FEES
W.rer Heate _'2, 11 Size 1�•r �J
Ware, Closets 2� Material
bath Tubs To Curb
Showers To Prop. Line
Lavatories 3 To Existing
Kitchen Sinks Not Conn.
Dish Washers Se er oxes
Waste Disposals �ti�, �� .FC.
Wash Trays STORM DRAINAGE
Washing Machines ,� Size
Water Softeners Material
Bar Sinks To Main Drain-
Comb. Sink s Trays To�6tirb�
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Sizet r�u
Restaurant Sinks Materia W I 11's-o
San Traps TOTAL FEES
Urinals Fixture Fee ,SLI
Area Drains Main Drain Fee
Water Leadersrai Fee-
Sprinkler Valves Water Sys. Fee
Permit Fee �.pp
TOTAL TOTAL FEE Q I
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final