51037 ' o
77 / LOT NO.
Q E
OR PLUMBING PERMIT
W1 ,,I,,,tij,n
AN 21 1965 C OF CUPERTINO
Sanitary No.
d6`S Permit No 03 ,Pee $is hereby made to the City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i- and/or fixtures in accordance with the provisions of the Plumbing Cade of the City of
a w Cupertino, and all othC
s applicable the to
Use of Premises
0 3 Owner �(/` Address /p 7 16,,
CV
Z J U1�-//A
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O99 pp CONTRA O-7, AGENT
3 m o e"-/ 7
�—�/� If
a State Licens���/ Approved
a
/ 6
PLUMB G INSPECCOR
DURES
UNITS FEES UNITS FEES
Water Heate Size
Water Closes Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
TVAs'h 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
Sand Traps TOTAL FEES
Urinals Fixture Fee' i
Waiter
Drains Main Drain Fee
W Ater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL / TOTAL FEE 44
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough Complete..
Main Drain
Final...