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No. Street Lot No. 30
(CATION FOR PLUMBING PERMIT
j CITY OF CUPERTINO
�pEe 1 19 O Sanitary No.
Date < II 3 119-10 Permit No. .5'
C11 OF CUPERTINO Fee $ 81. S0
plication 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
laws applicable thereto.
Use of Premises m>—,S • S U M rni
Owner+✓Q�/ GOtiST C`n
By SA -._I )a5£ F'1 PzAFVJILAL lti1C�
Contractor, Agent
Phone 21 SgO�k-:-
State License
Address
AddresstW oCeOS AUr, SJ .
Z./f-70
Approved i
lumbing Inspector �r/
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units
Fees
Water Heater
Size e}"
Water Closet
ty
Material GI
Bath Tub
8
To Curb
Shower
To Prop. Line
Lavatories
Iv
To Existing
Kitchen in
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 I,i
Restaurant Sink
Material G
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
b °%
Area Drain
11 Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee
i
Relief Valve
11 Gas Fee
yup
Vac Breaker
Skimmer
Filter
Permit Fee
y4%
Total
4
Total Fee
b