51145 (2) CUP'— LOT NO.
NO. STREE,I'
APPLICATION FO,R PLUMBING PERMIT
d ° CITY OF CUPERTINO
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o < Date c��Ls �7 196— Permit No
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� Application is hereby made to the 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
H 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. '
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oa Owner /r-tA.c<.i.t`LL �C3'L�'L��L-�. Address a/J 3.3 ��'t"4"'C'CA
WATER CONDITIONING
J z gy 12242 SaratoaalSunnwa.o u92n Address
o Saratoga, California 95010
m Phone
3 a3�-6083
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_U � CONTRACTOR, AGENT
FIXTURES NUMBER AI DRAIN
UNITS FEES UNITSI FEES
Water Heater size
Water Closets Material
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
Water Softeners 3,50 Material
Bar Sinks To Main Drain
Cnmb. Sinlf a Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee S. SD
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Naives Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
underground Rough...
.Partial Rough..
.Roump
gh. Colete..
\4ain Drain
Final...