51116 106 0 / l^ri✓ LOT NO.
NO. STREET
LII .N FOR PLUMBING PERMIT
z < p OF CUPERTINO
x 0 ) Sanitary No.
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0 a Date .`��' , . r� ` J—r-7 Permit No -f/// 6
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ww V�/ n(�rr Fee $j,Sy
° idatidd'1s hl �j �& City of Cupertino for a permit to install plumbing
`o < pipes and/or fixtures hste on t e reverse side hereof, and agrees to install said prices
a 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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w Use of Premises
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o a Owner IZA-r n (a�(�r o�, U�1{1-1 A-l_il�Y�1�,,Adddress 1 0 604 (�Cwcl
� o By C�2 0 } sTCQ V11 UJJ � -u�" Xddress 17176
3 o CONTRACTOR, AGENT
- Phone Q 7 — C O
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aa �S� �� 1 �(� Approved
o State License
U PLUMBING INSPECTOR
FIXTURES NUMBER MAIN
UNITS/ FEES UNITS FEES
`mater Heate Size
Ware, 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 . Sinks Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER.SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee 0c,
Area Drains Main Drain Fee
mater Leaders Storm Drain Fee
Svrinkler Valves Water Sys. Fee �•(] (J
Permit Fee O
TOTAL TOTALFEE
RECORD OF INSPECTION
_Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final...