51140 LOT NO.
NO.
N OR PLUMBING PERMIT
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' 0 IJUL 1mt, 9 1965 Sanitary No.
0 ' Date 196— Permit No.
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LL CITY OF qU ff RT1�VO Pees �`==t
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QTY is here y mace to 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
'z m and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws appli Ic thereto..
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1- 3 Owner C-.S et ter' Address �// " �� �I,L�lYL ui✓/
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z IJYA�..I,ll;.t[L�: 9�..S+�Yf„Qi Address-22 71 C F.GGCLLL t.t,.i('l SC
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o`o, / State License / 6 �/ 7 Approved,
e}-f PLUMBING INSPECTOR
FIXTum.s NU, BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heatc 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
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Hoor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
TVater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee ✓�
TOTAL TOTAL FEE pO
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final