1497 (2) LOT NO.
NO. STREET
vC R PLUMBING PERMIT
V� I F CUPERTINO
d.�4PR 2 ,/p 7
Date ��/ 9�� Permit No. l7'
CITY OF CUPERTINO Fee $ ��'
aApplication 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
Z, Cupertino, and all other laws applicable perti pp a thereto.
Use of Premises
rn Owner L�Fran.ue O,Ooar�Ti<r Address_ L'i,"eM.vn i.�
By Address "L
`
7COMMCTOR, AGENTt(�1 hone 37 r- Approve
�T PLUMBING INSPECTOR
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• I URL UMB•R M R
UNITS FGIiS IUNITS FEES
Size
Water'Heater I 1/
Water C osets �• I II Material G/ I
Rath Tubs / To Curb I I
Showers ( ( I To Prop. Line
Lavatories I Z I I_To Existing I
Kitchen Sinks ( N Conn. .L
Dish Washers
Waste Disposals
Wash Trays i STORM DRAINAGE
Washing Machines I II Size I I
Water Softeners I I II Material
Bar Sinks To Main Drain
Comb. Sink-& Trays II To Curb I_ _
Dental Units I I�
Drinking Fountains) _ I _
Floor Drains ( II WATER SYSTEM
Hoppers I -III Size 7y I_1_
Restaurant Sinks I I Material �R,t ✓ I
Sand Traps I I II TOTAL FEES
Urinals-11 II Fixtuce Fee I /, JJ
'i Area D�r-ainsj 1 II Main Drain Fee �, J
Water.Leaders I Storm Drain Fee
�. SPr' kler Valves I I II Water Sys. Fee I U°
Permit Fee /. o
TOTAL TOTAL FEE i y, ,� uI
C RD OF INSPECTION
Partial Rough
Rough Comp
l to
Final Q t
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