51118 �I-�C11LJ- I / /Li��y{r�[i/ /9]� LOT NO.
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AP-PAICAMON FOR PLUMBING PERMIT
W z C OF CUPERTINO
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x o Sanitary No.
3 a Date 20 Permit No.
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W W Fee$.�? 'f
' 0 Ap(f�r}t�n aero 1�Q t���ity of Cupertino for a permit to install plumbing
o a pipes MtdV_ r ( res�(�ILfdLe�RF�J�}berse 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 other laws applicable thereto.
oo Use of Premises
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o a Owner u✓�PC L�wyi^P Address
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3 F O y CONTRACTOR,AGENT Add[ess
- 0 Phone X ;z S.3— ?SicS' 7
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a BVILZIAM D. BENEVICH
10 State License Approved
PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater 731;-Size
Water Closet Material
Bath Tub To Curb
Shower 0 To Prot).Line
Lavatories Existing
Dish Washer
Waste Dis sal
Wash Tra Lq-
ST DRAINAGE
W Machin ' Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee % z
Area Drain Main Drain Fee
Water de o Drain Fee
Sprinkler System Water Sys.Fee
Relief Valve Gaq F�
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total I I Total Fee , S 7e
CITY OF CUPERTINO
10300 Torre Ave.
CORRECTION NOTICE
Deparfm&
Job Located at -%Q.5—D3.-- ri- _
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You are hereby notified that no more work shall be
done until the above violations are corrected. When
corrections have been made call the inspector.
252.4505 Date: ---
City Telephone Inspector: �b� u