999 p�OJ�i. �� Clz AI Vd . LOT NO.
NO. -LLM ET
APpL CATION FOR PLUMBING PERMIT_, p •
111111 'CITY OF CUPERTINO
\J {A✓I (1�S l
nEr. 20 1960 , 195_ Permit No. `I J
Fee $
l Ci}l Mt5 SsuEPTINQ
pli on r 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
Q and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
\ Cupertino, and all othe laws applicable thereto.
8 Use of Premises
Owne
pvl � . CIAU ��Addr ss
SIt �1. tCV,K i
N �..-1� 1 ,;
B �, 1. •��iii!! Ad s . f�.Cl� G%i�(�
Y _
C CONTMCTOR, AGENT " =a.. '_;� A Ad
•Phone (�nj` j _ '-Approve AAAd
�1 / " � w• �.¢*. �„L• �.,PMBING INSPEC OR�\
! .�y Ru•.P„-• J
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate• Size •I
Water C1obLts Material .�
Bath Tubs To Curb
Showers To Prop. Line''
Lavatories To Existing •�
Kitchen Sinks �� N Conn x
Dish Washers O=W=K EiW ES
Waste Disposals '�' �s
Wash Trays STORM`DRAI AGE
Washing Machines Size
Water Softeners Material 'I
Bar Sinks To Main Drain .�
Comb. Sink s Traysl 111 To Curb
r
ental Units iI �_
Drinking Fountains) I iI -
Floor Drains WATER SYSTEM
Hoppers �� Size
Restaurant Sinks Material
Sand Traps T A_L FEES
Urinals
Area Drains Main Drai'ri-Fee- , ,�A�jz. • i
Water Leaders Storm Drain'Fee -
Sprinkler Vawes I Water Sys. Fee.+ -�
Permit Fee
TOTAL TOTAL--FEE �ySrS
RECORD OF INSPECTION
Partial Wuph +
Rough Complete
Final
,r
Cupertino Sannq�j
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
F-j Sewer Connection Sanitary Permit No. ---- .........
--- ---
Fi-j—Plunibing Final Plumbing Permit No. ....9-9.9............
LotNo. ----------------------------
Owner or Tenant
. ............ . .........
- ---- -----
At
Tract -----------------—---------------- ............
---- - ------- ----- ---- ---- ----
Date Connected .....-- ........../v/,1f
.......................................... ------ --
Date Final ...... ------------------------71lool"'
...............--------..........-t....`......----.----- 196-----
1.1t 1/(0-500 P iUMBING INSPECTOR