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FOR PLUMBING PERMIT
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x oA ,� Sanitary No,
0 Dae 4' 1966/ Permit No
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° het i{ljdyptp(��lothe City of Cupertino for a permit to install Plumbing
o a pipes and/or fixY� c, t .d 1i rc 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
a w Cupertino, and all tither laws applicable thereto.
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� LL Use of Premises
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3 Owner T� ar X9ev Yv °a Address 'L2ZOV IMc C. lRll4^
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- Phone 2 1 3 -
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ao State License 90 17 9 x,53 Approve
U PLUMBING INSPECTOR �/
FIXTURES D CIN DRAIN
UNITS FEES UNITS FEES
Water Heate I Size
Water Closets Material
bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish1Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Star Sinks To Main Drain
Com . Sink, Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee . o O
Area Drains / / C Main Drain Fee
Ta—ter Leaders Storm Drain Fee
Sp n - , Vales Water Sys. Fee
I Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final