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LOT NO.
NO, STREfiT
APPLICATION FOR PLUMBING PERMIT
a ® TY OF CUPERTINO
r o Sanitary No.
O a Dat 1961 Permit No.
3� s�
_ Fee $ 3
O Apple City of Cupertino for a permit to install plumbing
o a pi ppti/ xt r I� W reverse side hereof, and agrees to install said prices
> and if) of fiat res in accordance with the provisions of the Plumbing Code of the City of
Z Cupertino, and all other laws applicable thereto.
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.a, .. Use of Premises 2e S
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3 OwnerfiA11r!2Hd/. N • Address Si4h C
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o CONTRACTOR, AGFr
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— Phone 25 -7 8/O
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aState License,2 3 7 10 Approved
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PLUMBING INSPECTOR
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UNITS FEES UNITS FEES
Water Heate / ('10 Size
Water Closets MaLcqLal
Bath Tubs 0.0
Sbowpr t Prop. the
Lav uries Exis ' g
K' chen Not nn.
Ish Was Sewer Boxes
ante Dis
It Trays STORM DRAINAGE
W Ma ' es Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drin ing Fountains
Floor Drains WATER.SYSTEM
oppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee „S o
rea rains Main Drain Fee
Water-Leaders Storm Drain Fee
Tprinkler Valves Water Sys. Fee
Permit Fee J,0 0
TOTAL TOTAL FEE 3.Jo
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final
CITY OF CUPERTINO
10300 Torre Ave.
CORRECTION NOTICE
----------------------
Department
Job Located at
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q...FIX-. 45ak..A.T 7- t..T.-PA.il-
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----------------------- ---------------- -------------------------- ------------
You are hereby notified that no more work shall be
done until the above violations are corrected. When
corrections have been made call the inspector.
pp
252-4505 Date: .12. 2
City Telephone Inspector: .h