51037 (4 LOT NO.
NO. SnE.E.a1,LT FOR PLUMBING PERMIT
z a ® OF CUPkRTINO
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ro Sanitary No.
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0 Date 19615 Permit No
3 `
U Pee $
W LL 0 nY, ,tiQF, tGO,ER M
e City of Cupertino for a permit to install plumbing;
o w pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i Iand/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a W Cupertino, and all ie laws applicab roto.
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a W Use of Premises
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r 3 Owner A ess
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O CONTRA-' OR, AGENT
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ao tate Licens�y / % U Approved
0 `� /� `2 �J PLUMBING INSPECTOR
FIXTURES J
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatunes To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
W ash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink m Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Zr/ater Leaders Storm Drain Fee
Sprinkler Valves Wate[ Sis. Fee •�
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final