51181oa. J 1l�- 1 / " , (/ CLL , ,/d LOT NO. 4/i
NO. STAT
LIO�M010 PLUMBING PERMIT
foa����ERTINO
i Sanitary Nu.
Date i, F B 27 196�G Permit No .S
(� �/ /� C n Pee S6.3 0
Applicatio'c",hFrelAPirnad�r'LdlgCef?T4�o'qupertino for a permit to install plumbing
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
-Cupertino; and -all -other -laws applicable thereto.
Use of Premises , 4=• 'Z)
State License. 'P : Deg 3 `�
�U
Addressa�9 P 41Q 64.44f Y&
Z LY
Address D �J
J
Approved /
1- PLUMBING INSPECTOR V
By.�'-
CONTRACT
Phone 'y� /Y'q
,AGENT
O O
State License. 'P : Deg 3 `�
�U
Addressa�9 P 41Q 64.44f Y&
Z LY
Address D �J
J
Approved /
1- PLUMBING INSPECTOR V
FIXTURES
I NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Ileater
O
Size
Water Closet
� O
Material &7. .
Bath 'Cub
/ /,:SD
To Curb
Shower
/• So
To Prop. Line
Lavatories
5-0
To Existing
Kitchen Sink
1 J D
Not Conn.
Dish Washer
/ -0—
Sewer Box
Waste Disposal
Wash Tra
STORM DRAINAGE
Washing Machine.S
d
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinkin Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TO'T'AL FEES
Urinal
Fixture Fee /6•S o
Area Drain
Main Drain Fee.S : e o
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee „_y ,o
Relief Valve
Gas Fee „fD
Vac Breaker
Skimmer
Filter
Permit Fee
Total
'Total Fee a�L 5'v