591 (2) , / J! � LOT NO.
• / ,NO. ,may, STREET ,
} T FOR PLUMBING PERMIT
OF CUPERTINO
?N0V 20 9959 -o
Date&CCS /f , 195 `� l® mit No. /
CITY OF CUPERTI � Pee $ Id-
Application is hereby a t ty f Cupertino for a permit to install plumbing
pipes and/or fixtures Ii verse side hereof, and agrees to install said prices
and/or fixtures in accord ith the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises —A /
. Owner // C Gh ESL s Address Ce�zr /'iHo%c a
By f7 iia /Yc • Address,06'0 Fc>r c.i5`
CONTRACTO , AGENT , / '
Phone At.X- X— 7 y6 3 Approved—Cd
T
//PLUMBING INSPECTOR '
•FIXTURES NUMBER MAIN DRAIN
I UNITS FRES UNITS FEES
Water Heater / j 11 Size
Water Closets Z Material .i C :L
Bath 'Subs j To Curb j
Showers To Prop. Line /j
Lavatories Z To Existingi d
Kitchen Sinks IT - i'Conn.f ��Y0
Dish Washers j i
Waste Disposals
Wash Trays j STORM DRAINAGE
Washing Machines'' I II Size
Water Softeners., . . Material j
Bar Sinks . .j II To Main Drain
Comb. Sink & TPaysj j To Curb j
Dental Umts , j j�
Dnnkmg.Fountams II
Floor Drams II WATER SYSTEM
Hoppers Size
Restaurant Sinks j j Material
Sand Traps j TOTAL FEES
Urinals j Fixture Fee' -Ile'Qo
Area Drains j j Ij Main Drain Fee j��
Water Leaders - Storm Drain Fee .
Sprinkler Valves j j jj .Water Sys. Fee
permit Fee t j
-•TOTAL TOTAL FEE
RECORD OF-.INSPECTION '
Partial Rough y" l�
Rough Complete
Final i