51087 lo -117 "_~�T LOT NO.
NO. STREET
P4f FOR PLUMBING PERMIT
z a � OF CUPFRTINO
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x o Sanitary No.
OJ Date ln
Permit No
= LL Fee $
O A n er ]�j of Cupertino fora permit to install plumbing
'o < piped C/ r re klld474?4f ease side hereof, and arees to install sid prics
i < 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.
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LL Use of Premises
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� 3 Owner Address— /0 '%/'7.
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Address
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3 F CONTRACTOR, AGENT
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a`o,' Stare License -2 ,3/ '�r�n Approved `'-'-'
7,j PLUMBING INSPECTOR
FIXTURES I
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
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
rea Drains Main Drain Fee
Z�ater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE U
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough Complete..
.0ain Drain
Final...