51088.1 O • I �" - LOT NO.
NO. D
LIC�gtT FOR PLUMBING PERMIT
z pIv . TY OF CUPERTINO
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Sanitary No.
KLL
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Date ` , �JZ Permit No L
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w w �+ Pee $ —
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App>vt�t on is hereby made to the City of Cupertino for a permit to install plumbing
o 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
a w Cupertino, and all other laws applicable thereto.
~ r Use of Premises00
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3 Own �N A'Y'E Address I I
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z D U G111I`1A r Address <}-
3 O COOJ`7TRA�CTTOR, AGENT �w e
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arf State License Approved
Approved /
P{ PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees 11 Units Fees
Water Heater I 1 11 Size
Water Closet 1,,3 Material
Bath Tub To Curb
Shower To Prom.Line
Lavato ies To Existin
in 1 t 1 11 Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine' Size
Watq S terser IMaterial
mk To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Ho er Size
Restaurant Sink Material
Sand Tra TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
Relief Valve I F,
S
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee a- 0 J
Total Total Fee '� .5