1380 aa9S3' r C/ P ICL Lrt N� LOT NO.
NO. STREET^R
4
LITTON FOR PLUMBING PERMIT
OF CUPERTINO �y
rNo. . ' �d Q
Dat' 'r JAN I �`'19d�i Permit J�
�; Yn� rI Jn D n'n - Fee'$
Applicatio�t 'is h�i2fiy �8��b'ff� 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 "
Y and/or fixtures in accordance with the provisions of the Plumbing.Code of the City of
Cupertino, and all other laws applicaabllee/thereto.
Use of Premises
V Owne��,~ enCT IMAsen CMInre Address
�S By tOCO 6rn;W!?7j '%vunuo' Addres, J
C0NTRACT6R,AGENT:
Phone - Approve
1 PLUMBING INSPECTOR
--rMrURES NUMBER MAIN DRAIN
I UNITS I FRES'V UNITS :FEES
-Water Heater Size
Water Closets Material 1
Bath Tubs . j r To Curb
Showers To Prop. Line
Lavatories . - - v To Existing
Kitchen Sinks r - Not Conn. I
Dish Washers
Waste Disposals,
Wash Trays - I STORM DRAINAGE
Washing'Machines Size
Water Softeners , Material j-
Bar Sinksr To Main Drain _
Comb. Sink &Trays ��. To Curb j
Dental Units IiI
Drinking Fountains] j jl
Floor Drains WATER SYSTEM
Hoppers j Sae
Restaurant Sinks Material
Sand Traps TOTAL FEES 61`
Urinals Fixture Fee j
Area Drains Main Drain Eee-j;,,,._;
Water Leaders. 11 Storm Drain•Fee I
Sprinkler Valves j j j Water Sys. Fee
SEWER BOXES `j Permit Fee
TOTAL ,TOTAL FEE '
RECORD OF INSPECTION
Partial Rough
Rough Complete >.
Final