854 .-! D/,2 nLIiC� N i` i LOT NO. ��/
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APPLIC N FOR PLUMBING PERMIT
2 196 1TY O//��F��CUPERTINO ( (�
Cj3�tg f , 195-' Permit No.
Fee $ .20
Application is hereby made to the City of Cupertino for a permit to install plumbing
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
dJ Cupertino, and all other laws applicable thereto.
8 Use of 1fremises
v
Owner i.. c� Address
By -AMNL Address 0 Say.
CONTMCTOR AGHNT � �'-7 •
Phone�t •L ' 7 Q Approved` sG6 Ci
PLUMBING INSPECTOR
J'�-
--FI—XTT)RES I NUMBER 11 MA N_ DRAIN r 1
I UNITS I FEES II A , JUNITSIPFEES
Water Heater Size - '' '1 .1
Water Closets Material
Bath Tubs To Curb "I �" X
Showers To Prop. Line =
Lavatories To Existing
Kitchen Sinks Not Conn. �..�
Dish Washers 11 SEWER EI0XE4 I t
Waste Disposals I I I ,.
Wash Trays STORM DRAINAGE
Washing Machines I Size
Water Softeners Material
Bar Sinks To Main Drain
Co . Sink s Trays To Curb
Denial Units
Drinking Fountains)
Hoor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES-
Urinals Fixture Fee.
Area Drains Main Drain;Fee;,I
Water Leaders ,� �� Storm Drain FW,'Ilv'W
Sprinkler Vatves .4. I I Water Sys. Fee ..r
Permit Fee -`
TOTAL �� TOTAL FEE ..
RECORD OF INSPECTION
Partial Rough
Rough Comp
Final 7
I, the undersig;ne do hereby certify that I am
,he owner and occup nt of the single family dwelling at
for which I am making
application to do C/� i
work as a home otmer. �
I also certify thnt I will not hire any non licensed
or contractor, but will do this work myself.
TELMONE, FIMiB f
'.SIGLST