1654 (2) IIZa� I J aI C�
LOT NO.
' NO. STREET y I
IIC s { FOR PLUMBING PERMIT
pF CUPERTINO
Date bL 5_ Permit No.
M CITY OF CUPWINO Fee $
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
y and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
L Use of Premises
Owner Qi As�=Q-e Address !e
�� By � 6 Address G !✓ - -.�a.w.
CONTRACTOR, AGEN
Phone 3 CA 77 "T .
Approve
� - PLUMBING INSPE 0
Iw
SURES NUMBER _,.;* ;SIN DRAIN
I UNITS I-'FEES kA'-a* UNITS FEES
Water Heater
Water Closets Iofatera e.,9.1
Bath Tubs Td Curb
Showers / ':2r 11, To Prop. Line
Lavatories 3 I To Existing
Kitchen Sinks Not(Lofiri.-
Dish Washers / �� /Jj, ,r� � _
Waste Disposals --�
Wash Trays STORM DRAINAGE
Wahing Machines l Size
Witer Softeners Material j
Bar Sinks To Main Drains ,
Comb. Sink s Traysl l ll To Curb
Dental Units l 1 11
' Drinking Fountains) II
Floor Drains WATER SYS` EM
Hoppers Size
Restaurant Sinks Material t
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee �,��
Water Leaders Storm Drain Fee
Sprinkler Valves I II Water Sys. Fee I /, cc
�l Permit Fee J5
TOTAL / j All TOTAL.$EE JVZhA
RE ORD OF SPECTION
Partial Rough )
Rough plete i
Final 2_
m:
Bldg. Dept.
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
Sewer Connection Sanitary Permit No. .....0�
..................
Plumbing Final Plumbing Permit No.
ofNo. .... ....... ............
Co
1 ---------------
1W- -- - ..............
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Owner or Tenant ---- --— ---------- - ----- .....a
At -------
- -- ---- - ---------------------------------------------------
Tract .................. . . . .. ... ..... ............. ...
Date Connected ------ ....................
Date Final ..................................
---- --------- ....... I qv.7-
-- ----- ---- ------------ -----------------
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LUMBINdINSPECTOR
11IL7/61-500