51138 (2) OT NO.
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APP N FOR PLUMBING PERMIT
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3 U TtY 9 196 b Permit No%J11 %jul E-1111
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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
> r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other lar applicable thereto.
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� LL Use of Premises S-
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O CONTRACTOR, AGENT
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0Q £ State License a Ir? s,3 64 Approved z749?.5,t�.-�w.�//
U°,JI- PLUMBING INSPECTOR
FIXTURES
UNITS FEES UNITS FEES
Water Heate / Size y"
Water Closets Material CZ!
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
\t ash Trays / STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink a Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size / "
Restaurant Sinks _. Material 7,4Z,
San Traps TOTAL FEES
Urinals Fixture Fee 0'5
Area Drains Main Drain Fee 0
'R/ater Leaders Storm Drain Fee
Sprinkler Vatves Water Sys. Fee �, 05
Permit Fee L r'
TOTAL TOTAL FEE tea
RECORD OF INSPECTION
Underground Rough '
Partial Rough
Rough. Complete
Main Drain
Final