51145 (3) GCJ G/a �7/s��/U/ LOT NO.
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NO. TR
D IAFOR PLUMBING PERMIT
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Y OP CUPERTINO
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Sanitary \u.
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o < Uate 196— Permit No. '
LL ��TY �F . �U�ERTINO Pee S�7 ""
0 I p IcatI n Is ere y in; e to the City of Cupertino for a permit to install plumbing
'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
a w Cupertino, and all other laws applicable thereto.
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w Use of Premises
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a 0 State Licensee 3 -2- 3y f/G Approved
PLUMBING INSPECTOR
111XIURES NUklBLR
UNITS FEES UNITS FEES
Water Heate Size
Ware. Closets Material 1
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks i Not Conn.
Dish Washers I Sewer Boxes
Waste Disposals
lkrasst Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material -
San Traps TOTAL FEES
Urinals Fixture Fee O"
Area Drains Main Drain Fee q
Vater Leaders Storm Drain Fee
Sprinkler Valves I Water Sys. Fee r I;r9
Permit Fee
TOTAL _ TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final