1263 LOT NO. '� r
NO. STREET �• .
AA R PLUMBING PERMIT---"-"-
J f®, y ry CUPERTINO - p
Date '""�" �l 09 � 195_ Permit No. / Z
�iF
�b Fee $ .
CITY OF CUPERTINO:.
Application is hereby made to the City of Cupertino for a permit to Zstall plumbing
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
Cupertino, and all other laws applicable thereto.
Use of Premises
/ i-A� I:,
a . .. nI
Owne'r f 01- 0 r A ES Addres
gy ILI — �o SES _ Address � t2+ � t per• 1
CONTRACTOR, AGENT ' i
t one L O, 6 0 - _ Approved _
fit, � t It) ✓:;� PLUMBING`INSPE TO '
FIXTURES NUMBER � '. MAIN DRAIN
I UNITS I:FEES',11 FI IUNITSI•FEES
Water Heater I r II Size 1 l
Water Clusets Z Material ` l j
Bath Tubs 'f; To'Curb j -
Showers ,} / To Prop. Line
Lavatories 3' To ;Existing)
Kitchen Sinks
Dish Washers.
Waste Disposals I / ••'a
Wash Trays :•- STORM'DRAINAGE"--
Washing Machines f Ir; = ,- I• Size ( •�
Water Softeners �,r^.;, Material
Bar Sinks';i-. 11 To Main Drain I.
Comb. Sink�,Trays ?,•.'- To Curb „• �_
Dental Units ' + '
I-
Drinking;Fountainsl 1: ?:. II
Floor Drains WATER SYSTEM,
Hoppers Size'.�� ':'•c.'. - :•I —
Restaurant Sinks -:;tl Ivtaterial'=y"a% i 4QS.tV
Sand Traps ._k :.TOTAL FEES
Urinals ' '' Imo^ - Fixture Fee'' _
Area Drains Main,Draih,Fee
Water'Leaders _? Storm-Drain Fee
_Spm V.wc- �', Il'Water•'Sys:'"Fee
riI /
�+-••ten eoxES rmitiFee
TOTAL / TOTAL.FEEJ,H / 'Q
•t RE RD. )F INSPE ION
Partial Rough Q
Rough Ccinplete -.Ret.t�',A
Final
Cupertino Sanitary
_Office Copy,
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
❑ Sewer Connection Sanitary Permit No., :^vs_;.........
Plumbing Final Plumbing Permit No. ./- 1� 3-:---- "•
Lot N.
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' Oemer or Tenant ...
....... ... ................._....---..._..... - ...�---------...----- ----
Tract ........................._._-...--'---" -.1.....-......--:..-.........._.._..._..----...._.:_.--..._--..
Date Connected ..........:-'-.--..........._......-�.R.--...--._ 19
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` .jDate:Pirial ----------------- qp�
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111UABING INSPECTOR'•";1'=� �Y--
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