1653 (2) LOT NO.
NO. T
® 1IW FOR PLUMBING PERMIT
t`��ryK'°
Irl.] OFF CUPERTINO ' 7
Date �f JUL ` /36� io4 � Permit No. /L 1d
CITY OF CUPERTINO Fee$ Xy1W—
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
Cupertino, and all other2wsap licable thereto.
Use.of Premises
:a
h + Owri --+ Address 4041CA.> s€
By "' - " Address .6 -
t
IT
CONTRACT'AGENT �
Phone 5- �Approved
;PLUMBING INSPECTOR
:.Ta. '1:3'.
I'IIURES NUMBER MAIN DRAIN
I UNITS I FEES jj, ft, IUNITSI FEES
Water Heater -Ilk Size I
Water ClosetsI Q II Material T I I
Bath Tubs I II:�1 Curb I I
Showers , I Ififfo Prop. Line I I
Lavatories II1T^o Existing
Kitchen Sinks I I I1"of C n .
Dish Washers
II V
Waste Disposals I;� I 9I,
Wash Trays II ;`' STORM DRAINAGE
Washing Machines I I Size Y I {
Water Softeners "Material /
Bar Sinks II To Main Drain I I
Comb. Sink s Trays I I To Curb _
Dental Units I I
Drinking Fountainsl III
Floor Drains WATER SYSTEM
Hoppers I I II Size I I_
,iRestaurant Sinks I .MSterial
Sand Traps I I _IIS, TOTAL TOTAL FEES
Urinals I I II4;'Fiiiture Fee I ,
Area Drains I I IL:Main Drain Fee
Water Leaders II :Storm Drain-- Fee,
ee;,
SP kl r Vaves I "14 Wat&L,Sys. Fee'
''JI Pe'rrmit Fee 9C
TOTAL I ,f pp I". TOTIArL FEE l q, Q
RECORD OF CTIQN
Partial Rough
Rough plete
Final
Bldg. Dept.
Office C6py
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
❑ Sewer Connection Sanitary Permit No. ..��..Lo...-�^.. .-...
[ .,-Flumbing Final Plumbing Permit No. .../(KeJ .5........
f
A
-
p Owner or Tena .. ..At J --------------- ...Tract ------------_--- g/.. DDate Connected //-l1........... ..... - - -------------
/ /
Date Final ------------------ .................Y`- ------ ---- - .-----..._----.----.... 19.L-Z".
h
PLU BING INSPECTOR
111 7/61-500