638 (2) LOT NO.
') ` y NO. .. STREET
a APP�L'ICATION�,FOR PLUMBING PERMIT
�j
Date
RAN
Permit No.���&6I OFCUPERTINO I I 2 0 11"(30 �� ' 6 �
' 195'!
CIIY ^l l —nT)ppl� Fee $ �S�v
Application is hereby'made OthefCity 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 fixturminaccordance with the provisions of the Plumbing Code of the City of
Cuperti
no,IHH all other laws applicable thereto.
Use of Premises
:a
Owner Address
,' By Address
DO rxnCTOR, AGENT
Phone ApprovedMLl_IAM D—aZ VAC, _
PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
I UNITS FEES II IUNITS I FEES
Water Heater S12e
Water Closets Material a _�
Bath TLib-sI 1 11 To Curb
Showers 11 To Prop. Line
Lavatories To Existing
Kitchen Sinks Conner.
Dish Washers
Waste Disposals
Wash.Trays STORM DRAINAGE
Washing Machines I / II Size I.
Water Softeners �� Material j
Bar Sinks ToMain Drain
Comb. Sink &Trays To Curb
Dental Units
Drinking Fountains) � it
Floor Drains WATER SYSTEM
Hoppers Size -
. Resthurant Sinks Material
Sandi Traps T L FEES
Urinals Fixture -Fee
Area Drains Main Drain Fee /p0
Water Leaders Storm Drain Fee
6prinkler Valves II Water Sys. Fee (J
11 Permit Fee 16
TOTAL 11 TOTAL FEE /, p C)
RECORD OF INSPECTION
Par"alRough
Rough.Com tete
Final'" ,5;27 \\
^�.
�...• �� � � Cape Sanitary
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
❑ Sewer Connection Sanitary Permit No. ...... ............
[1]� Plumbing Final Plumbing Permit No. .......(41,3
�J ... . . ....-.. '.... / . Lo,t,,PNoi. .O....e.....?.4 ........
...
Owner orTenant
... ... 1/� v ........... ......
At ...... iet;
� ....
Tract .......... - ti ..
...._ p_..................---.....--'---............._..............-
I 1.
Date Connected ...................................... /. 19..6p.
DateFinal ................................................ .. .7 19l?V.
................ ...................... ..... .....
................ ....................::
PLLMB1NG INSPECTOR
111 7/59-500 t y