2003 .Y.QA-L2' - LUT N0.1c` c b�
E' T %
FOR PLUMBING PERMIT
�r"�aP�IAR 2 91963 GPITY OF CUPERTINOta� aC
Daze 1�3 Permit No. ( �
CITY F CCPERTVM Fee$ "o
Application is hereby made to 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
and/or fixtures in accordance with the provisions,.of the Plumbing Code of the City of
a� Cupertino, and all other laws applicable thereto.
VUse of Premises
a
Owner � Address Z�, 2-e576
I �
By Addressd — / is
CO CTOR, GEM
Phone '� 5 ° �cF Approve
PLUMBING INSPECTOR
1
URT � UMB : M I R
I UNITS I FEES II IUNITSI FEES
Water Heater i I Size 4"
ater C osets Material G �.
ath Tubs To Curb
Showers To Prop. Line
Lavatories o Exis '�
Kitchen Sinks an — _JI
ish Washers �� 3EW=R-99XE3
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Maclllne!i SIzc 1
Wate 7 Softeners j Mated I
Har Sinks Io Main -rain
Cotnb. Sink a Trays �� To Curb
Dental Units'
Drinking Fountains� � �I
'Floor Drains WATER SYSTEM
Hoppers Size I_�
'Restaurant Sinks Material 7
Sand Traps TOTAL FEES
EUrinals Fixture Fee 333 =
Arca Drains Main Drain Fee
Water Leaders _� �� Storm Drain Fee _
;Sprinkler Valves I II Water Sys. Fee _42e
'"—`— Permit Fee „2 .a
TOTAL1:33 i--j T TAL FEE K 0-4-_
RECORD OF INSPCTION
Partial Rough —
'Plough Complete Q, N
`Final
6- .Z4"