100083 /6 s
OT NO.
NO. STR EF.I'
ON FOR PLUMBING PERMIT
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z a d C P CUPERTINO
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Too Sanitary No.
< Date VMAY 11 Permit No
3� — o-ro
i Pee $ —
° Ap tuuyyn er � 016ity of Cupertino for a permit to install plumbing
o < pipes do dr f res YiHCd�4Ai•�ItA 4verse 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.
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a LL Use of Premises
00
`o a Owned ^alp L d �' l'L Address 1C�''�`'� L h .
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, , gy � 2 a :� d c tl ern b q Address--1 1 2 LJ t Fl am e
J O CONTRACTOR, AGENT
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Phone 7 -'1573 7
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ao State License y O Approved
PLUMBING INSPECTOR
1. RNWN BER MAIN DRAIN
UNITS FEES UNITS FEES
'mater Heate Size
Water Closes / 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 . Sinks Trays To Curb
Dental Units
Drinking Fountains Adak
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee 3 �n
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee Q=)
Permit Fee -2
TOTAL —3 TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final