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' LOT NO. �•
NO. STREET
A C� FOR PLUMBING PERMIT
EARI F CUPERTINO Date 18 196U _ Permit No. �o
� � WV;RTjN� Fee $ .3
App& ereby e t e Pty of Cupertino for a `permii 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
Cupertino, and all other laws apppllliicable'e to.
Use of Premise-t���st�s
By Address
CONTRACTOR AGENT
Phone 2.3 2A ? �-Approvedl
INSPECTOR
�XTURES NUMBER 11 MAIN DRAIN
UNITS I FSEs II IUNITS I FEES
Water Heater
Size I -
Water Closets
.,��
Material
Bath Tubs
To Curb
Showers )
To Prop. Line+•
Lavatoriee
To Existing -
Kitchen Sinks ,�
�� Not Conn. I
Dish Washers -
SEWER BOXES
Waste Disposals
Wash Trays
STORM DRAINAGE.
Washing Machines
it Size_
i I `
Water Softeners
�� Material '/,
:-.4"'
Bar Sinks .
�� To Main Drain
Comb�Sink a Trays
To Curb
Dental. Units
Drinking Fountains
Floor -Drains
WATER SYSTEM
Hoppers
-I
�l Size
Restaurant Sin
Material
Sand Traps
TOTAL FEES
Urinals
Area Drains
I -
I Fixture Fee
Main Drain Fee
Water Leaders
I II
Storm Drain Fee
Sprinkler Valves
Water Sys. Fee ,
/ oOOI�
Permit Fee I O
TOTAL
I 1�
TOTAL FEE 3 00
[. a .ti
I, kthe undersigned do here'gy certify -that I `:am
the owner and "ccupent of the single family dwelling at
Y �for which I -am, making
i
application to do work as a home owner:
I also :certify that' I will not./hire,
ot hire any
.1 -licensed
or cohtractor; bum will do this work m self.
a3, z .
=21HONE .19UIgIiEI SIGP:ATURE . IJ
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