100101 LOT NO.
NO. STR F.RT
gpitIr96.
FOR PLUMBING PERMIT
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OP CUPE,RTINO
l 3 196 sanitary No. �Pf 3
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o w Date, ..�-e Permit No
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oCITX QF . CIJe QE TINP Eees
pP icatton a fere y ma e to the City of Cupertino for a Permit to install Plumbing
`o < pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i m 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. `
w Use of Premises
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3 Owner Address
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Address -L/S/S-
CONTRACTOR, AeENT
- 0 Phone
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ao State License �3 9`�'� Approved
/�/— le PLUMBING INSPECTOR
•I. J � _
UNITS FEES /" _ y - UNITS FEES
Water Heate rSize
Water Cloacts Material
Bath Tubs ( T t
Showers To Prop. Lin` '
Lavatories �To-Existirig-
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
Floor Drains WATER.SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee g.&O
eater Leaders Storm Drain Fee
Jpri nkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE , pb
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
\•lain Drain
Final