51104 LOT NO.
NO. SnEft
J Rpj CIATJ FOR PLUMBING PERMIT
z a W OF CUPERTINO
xw R65
o Sanitary No.. _
W _ D E
o -' Date y 13 19 19 Permit No 4-//o '
3a
U tee $ �
W , Q��Y -fin f VyWINO
= O
� I cats is � y e City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r 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.
w x
� r
o_ o Use of Premises
1 N
O 3 Owner Address /
O J / Address-6/-7a /O
j o By eG '
CONT
RACTOR, AGENT
- 0 Phone
ao State License -Approved /Nt
U �[ PLUMBING INSPEC TOR
FIXTURES ABER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closets Maier.a'
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks ' Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
-.grater Softeners Material
Bar Sinks To Main Drain
Comb. Sink a Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
.Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler V;iives Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE14
a '
RECORD OF INSPECTION
Underground Rough...
.Partial Rough..
Rough. Complete..
Main Drain
Final...