2323 (2) 1f1S3 bli8oae ;r Ge Tana T- LOT NO. 2
NO. S'Tt1Il/EET -
fP7—TW19563-
FOR PLUMBING PERMIT
OF CUPERTINO
Permit No.
Cr II YY nnFC C Fee $
ATplicatf n is er&y made to he 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 other laws applicable thereto.
Use of Premises Residence
v
h Owner Blossom Valley HQMeE Address IC53)t ()range m.o_�r
ane
By Amaral Plwnbirw Address me
CONTRACTOR, AGENT
Phone .Aa6-3963 -T Approved -
PLUMBING INSPECTOR
—URES NUMBER 11 MAIN DRAIN
UNITS FEES II (UNITS I FEES
Water Heater Size
Water Closets ,3 ,$4'p 'Material CSI '
Bath Tubs / wa To Curb .
Showers ' ��,� To Prop. Line
Lavatories � � �, pall To Existing � �
Kitchen Sinks Not Conn. I'
Dish Washers / /✓Pi SEWER BOXES (-
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines /p-o 11 Size
Water Softeners 11 Material
Bar Sinks i To Main Drain
Camb. Sink,&Trays To Curb {
Dental Units
Dunking Fountains) I11 �_
Floor Drains 1 11 II WATER SYSTEM
�Hoppersj Size
Restaurant Sinks 11 Material
Sand Traps II TOTAL FEES
Urinals Fixture Fee v--o
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Vaives I II Water Sys. Fee Gr'a
1. Permit Fee
TOTAL TOTAL PEE 7 rrd
RECORD OF INSEFCT4Wq
Partial Rough
Rough Complete �'
Fi -
nal
A