51118 LOT NO.
NO. STI EP.T
CRV OP CUPWWO CITY OF CUPERTINO
z < APPLICATION FOR PLUMBING PERMIT
r 0 e)U{l 17 1 71 Sanitary No.
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0 a at 1/ 19 �� Permit No. 5
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�. Fee$
0 Application is hereby made to the City of Cupertino for a permit to install plumbing
o a pipes acid/or fixtures listed on the reverse side hereof, and agrees to install said prices
'z.ui 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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4 Use of Premises
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3 Owner C 45=1'2-1 Address -4760✓F
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3 0 CONTRACTOR, AGENT
st7.J S G`
- W Phone 2<Z— /7 91
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o State License zs7 ( Approved
PLUMBING INSPECTOR
FIXTURES NUMBER - MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop.Line
Lavatories o Existing
Kitchen k Not Conn-
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main.Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking.Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee
Relmef Valve Gas Fee
J
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total Total Fee ,06
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CITY OF CUPERTINO
10300 Torre Ave.
CORRECTION NOTICE
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Deparfmmnt U
Job Located at l�� .CCN *O ✓t ':
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You are hereby notified that no more work shall be
done until the above violations are corrected. When
corrections have been made call the inspecto .
252-4505 Date: �- /7—7
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City Telephone Inspector: -----_----- - _-___---
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