150077 LOT NO.
NO.
STPa
D 11 FOR PLUMBING PERMIT
a QIQ { OI' CUPERTINO
x o pAP 4 1966 llii...l ULUU��LL sanitary No . y� G
3 U Date196 Permit Nq,1/—d7-zt6
w 4CITY OF CUPERTINO Fee 5 S=
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Application is hereby made to the City of Cupertino for a permit to install plumbing
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o 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 Code of the City of
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Cupertino, and alt other laws applicable thereto.
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- n Use of Premises
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3 Owner HO.d Address 7 //_ 6J� 61 f e' AEZZ&Y R�
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o By 'tgA'D h Cf �LHlI. Address Z/f 45,J/I�KJoy1T SJ
3 F CONTRACTOR, AGLT
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a o State LicenseY1I(f7� Approved
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0 PLUMBING INSPECTOR �j
FIXTURES
UNITS FEES UNITSI FEES
Water Heate Size 4-
Water Closets Material cz
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
Comb. Sink v Trays To Curb
Dental Units
Drinking Fountains
floor Drains WATER SYSTEM
Hoppers Size !•
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee .1 #-V
I/ater Leaders Storm Drain Fee
Sprinkler Volves Water Sys. Fee lo
Permit Fee -." D
TOTAL TOTAL FEE �v�
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
\'lain Drain
Final