1153 LOT NO. f' 1
NO.IM
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Lil .L ATION FOR PLUMBING PERMIT
ITY OF. CUPERTINO `
1. t 195_ , Permit No. I �J
;-'`.:;{ • Fee $ 1
CleT ppli r on r the City of.Cupertino for•ajpermit tojinstall plumbing
L pipes and/or fixtures-listed on the reverse side hereof, and agrees to install said prices
and/or.fixtures in accordance with ovisiolis'.of.the Plumbin de of the City-of
Cupertino,;and �serraws app ble ereto., '-4
&' use emis -+-•.UW L�- w,� ►�.►.��I�a i""m0 1 .
ne Q Address• e, e'
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ddesrs• J."":'. -,• ,�y, .
dv • WNTRACfOR, AGENT
Y
hone Approv i
Ute'
1 PLUMBING INSPECT
• _ r.
FIXTURES NUMBER MAIN DRAIN
UNITS I' FEES UNITS FEES
Water Heater
- Size a '
Water Closets IMaterial (-
Bath Tubs II To Curb I I
Showers .,l To Prop. Line
Lavatories = L, , To,Existing,
Kitchen Sinks. '�. l,.I. Not Conn. _I
Dish Washers-!_ I `J I " -f'- iI it `` .•.
Waste Disosals .
Wash Trays - I )t,q I` !11= ..(STORM .DRAINAGE
Washing Machines I
Water Softeners'- :IS:'.;>I Material.
Bar Sinks ' �• . }. `;�.• ; IL Toh,Main Drain
Comb. Sink s Traysl (- I -�!,, - I -To!Curb
Dentin Units r. .i�, I `, L :{ i I_
Drinking Fountainsl �;1 I• '� _ II -' . • .;_ r_
Floor Drains WATER YST`M •:�
Hoppers Size
Restaurant Sinks Lr II Material
Sand Traps l ,. - I TOTAL,FEES.
Urinals I , 'I II Fixture Fee;
Area Drains I' II Maii% Draih Fee I -
Water Leaders . - ,, II Storrr,Drain Fee I
wes I lI7 II''Water',Sys. Fee I /.0
O
l4EWFR a a, I I .• , Permit Fee -. 1.o 0
TOTAL I II TOTAL FEE •.$• 00
RECORD OF INSPECTION
-----------------
Partial Rough, ,!• , :.I'.,;
Rough Complete -
Final4 / "•�'