51125 rI�A/ LOT NO.
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?fiAPR
T FOR PLUMBING PERMIT
1 1965 OF CUPERTINO
x p Sanitary No.
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o a Da1965 Permit No
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= w Fee $��
O 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
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws applicable�thereto.
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0 w Use of Premises
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oa Owner C"' � Llt.f�i Address 03 6 �q
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J zBy E N / t So CT W/1r412 Address/L13 � /P( e YCC 57 ,
3 0 ' /CONTRApCCOR,
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State License 17 7 :3 Approved
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_U PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
'slater Heate 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 Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
Moor Drains WATER.SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee'
Area Drains Main Drain Fee '
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee „2
TOTAL TOTAL FEE o�T/
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough, Complete..
Main Drain
Final...