51145 (3) a/�r X/lifH.L!�/IXCC-�A//(/� NO.
ND. STe EF.I'
rAP
1aT N FOR PLUMBING PERMIT
" a OF CUPF.RTINO
zz
x a Sanitary No.
oa Dat 13� 96
966 , � Permit No.
3u
w a Fee $ 15
� o '
A(ry�� in
he�¢��� ,^y' City of Cupertino for a permit to install plumbing
o < pipeCl d or�fl*turps ttStec'f'on e 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 ap
plic
a
bl
e thereto.
0 n Use of Premises
00 11 /�
3 Owner `1wf / � �.� Address ^
zz J CROWN PLMING INC`. CEOWrLUMING CO. INC.
o By P n Bair BO Address P. n. Bnv 809
3 < SafBttoW'l,�1alf9?hfi Saratoga. California
— m Phone
w z
ao State License__ d��� Approved
Uj I PLUMBING INSPECTOR I/
(sl
FIXTURES NUMBER MAIN DRAIN
UNITS FEES r UNErS FEES
Water Heate Size
Water Closets L Material
bath Tubs To Curb
Showers - To Prop. Line
Lavaturies 3 To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
as'h Trays STORM DRAINAGE
Was ing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drin ing Fountains
t`loor Drains WATER.SYSTEM
Hoppers ize
Restaurant Sinks Materia q j
San raps TOTAL FEES
rinals Fixture Fee jv,,9Q
—re a rains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler valves Water Sys. Fee // 6-0
Permit Fee ,
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough, Complete
Main Drain
Final