51189 - Lot No. 43o
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LIGATION FOR PLUMBING PERMIT JM 3
® CITY OF CUPERTINO
N�V O 31 70 Sanitary No. p
Date )) 3 , 197 Q Permit No.
CITY OF CUPERTINO 1 Fee $ Ct S�
Application is hereby made to the City of Cupertino for a permit to install plumbing pipes
and/or fixtures listed on the reverse side hereof, and agrees to install said prices and/or fixtures
,; in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all other
'c laws applicable thereto.
n Use of Premises W-rs
Owner Y Sk-/ rnIJS . Ce . Address
By SA[w) J-�SE KELAp+.11C.CL IVL
Contractor, Agent
Phone 904-4
State License 'ZL14 185
Addressl"< Q.aL-.V" Ali. 5.3.
11-1q?o
Approved
xFlIumbing Inspector
Per
Fee
Total +; Total Fee cl Sn
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units Fees
Water Heater
Size 41,
Water Closet
I-V
Material
Bath Tub
%
To Curb
Shower
°6
To Prop. Line
Lavatories
1 v
To Existing
Kitchen Sink
Not Conn,
Dish Washer
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size 1
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee -I Y
Area Drain
Main Drain Fee S°Oi
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee I ii
Relief Valy�,
Gas Fee °,
Vac Breaker
Skimmer
Filter
Per
Fee
Total +; Total Fee cl Sn