1265 (2) LOT NO:
NO. STREET .. .:
�® .OR PLUMBING PERMIT•�-� -s• �
CI -F CUPERTINO
Date 195° 'Permit No.
r CITY OF CUPERTINO Fee $__
-"Application is hereby made to.the.City of Cupertino for a permit to ' stall plumbing
pipes and/or fixtures listed on the: everse side hereof, and agrees to install said prices
�0 and/or fixtures in accordance wii6-Ihe provisions of the Plumbing.Code of'the City of
Cupertino, and all other laws applicable thereto. '
Use of Premises . / •'
Owner;/OLG, O'l 'L J Address ,�0 1 r
By /L' E — v, ca . Address J i OAC. S 7s
IQ'
CONTRACTOR AGENT- ;
Mone C 4 Approv
1 r x; PLUMBING INSPEC
FIXTURES I NUMBER 11 MAIN DRAIN
I UNITS I:�'FEES II -' (UNITS I'FEES
Water Hcater / I I .Size 14-
Water Closets 2 II-.Material C-T
Bath T- fs ! r I To,Curb I I
Showers' I -' »;•. II To Prop. Line �(
Lavatories . g? `. ':To.,Existing
Kitchen Sinks j '.:IF• •N t�,on
Dish Washers
Waste Disposals j' Imo'•- II-:
Wash Trays I';,',, I STORM DRAINAGE
Washing Machines / I :,i- II Size I
Water Softeners -";Ye II Material I I.
Bar Sinks: I I To Main Drain
Comb. Sink a Traysl I II To Curb I_ I
Dental Units'.- I .
Drinking Fountains) I' '
Floor Drains 11 WATER SYSTEM
Hoppers I ' II Size I3/u1I
Restaurant Sinks I .. I Material e�/aLU
Sand Traps II TOTAL FEES
Urinals I _ I Fixture Fee
Area Drains I :I• _ II -Main Drain Fee I ' /
Water Leaders I I Storm Drain Fee I
Sprinkler Vawcs II Water Sys. Fee
SEWER BOX¢ l —I Permit Fee /
TOTAL / ? TOTAL FEE: / , •S`J
1' REC RDFF I P N •�'3:
Partial Rough
Rough Cotnplete k3
Final Q 2
i
_ Cupe irtinaly
U.Iiicei,oPy ..
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO .
❑ Sewer Connection � � , Sanitary ,Permit No. .. .............
�Pliunbing Final , Plumbing Permit No. --. / ...........
Lot No; ......
Owner or Tenant ... .i.,f.�"!`�-. fir-
�'-n ..`�4 .....- ....r......... . . . ..... ...... . ...L� .'.............. .......:........:•
Tract . • -=---
.. a
Date Connected ....... A�/C�
Date Final -------------- ...........:.........-.... c2e-----------......-----........................ ING-------
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r� /rJ� • G�4.n �.,r�,
C - yJ - ,PLUNIBING INSPECTOR