1291 `' ��O' �—Iq`E `�Nl LOT NO. ef.
P %CPPLIC 'FOR PLUMBING PERMIT
r o ff 3 1961 Cl OF CUPERTINO
Date .,,ff- `+' (1 IN65_ � Permit No. /42 /
- Ufa '- Fee
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 ;
O { and/or fixtures in accordance with the provisions of the Plumbing Code oftthe City of, }
Cupertino, and all other laws applicable thereto.
Use of Premises
:a
' Owner IU'LC /70ti/E� Addte55T�y
ly Address7042 (R I I
• CO T�(`CTOA, AGENT '
i�honeCiApprove '
! PLUMBING INSPECTOR 1
—hIXTURLS NUMBER - MAIN.DRAIN
UNITS FEES �IUNITSI FEES
Water Heater-` ...!I Size ; `'
Water Closets - _ -II Material:- ; IG=
Bath Tubs I ( 1 -111 To:Curb 4
Showers\, I I I , ,111 ToPiopd Line V
Lavatories �I,.ToExisting
Kitchen Sinks t ."N Con
Dish Washers
-Waste Disposals �'., • { :-�,, '�
,Wash Trays II , STORM?DR'AINAGE
.Washing-Machines ) I I jI Size
Water Softeners 11 Materia( ; ;rid I '
+Bar Sinks I To Main Drain:l
Comb. Sink s Trays) I1 .To Curb
Dental Unit's 11
Drinking Fountainsl I II
Floor Drains WATER SYSTEM
-Hoppers FS,
_Restaurant Sinks Material R�,f
Sand Traps TOTAL FEES
Urinals Future
pArea Drains Main Drain Fee` - , pp
Water Leaders _ Storm Drain Fee
.Sprinkler Valves I Water Sys. Fee I I OO
SEWER BOXES OI II Permit Fee 1 ,00
TOTAL S0I II TOTAL FEE �• �p
RE O OF N TION
Partial Rcugh
� Rough Cole e , / le�
Final
Cupertino Sanitary
v, ,Office.Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
❑ Sewer Connection Sanitary Permit No.
. ........................
-/ q1 . .."..
Plumbing Final Plumbing Permit No. .. ....................
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Lot No-- '2.9....................
Owner or Tenant ------
..................I .............. . ........ --------...........:- ---------
At ......
..........7........................................0�1................
Tract --------------- ..................
Date Connected ----------------------- ..... .
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y.
Date Final ............. -----------------
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16,81t, 1/(0-500 4�,,IILUMBING INSPECI'OR 0",