51125 OT NO.
' NO. STREF.I'
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
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A pphca i y r,�a he _ f Cupertino for a permit to install plumbing
o < pipes land ta'P525 Irst�dElhc r side hereof, and agrees to install said prices
> and/or fixtures in acc ncc with the provisions of the Plumbing Code of the City of
w= Cupertinr�t>•q�'allr{ perdN t eieto.
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Use of Pr mises �� 2G
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3O Fr- 1,S tri�CJo[1�l •v u- Add r ss//_ 1-f L 1`L 1 `, Lc-1+
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L' Address � ilC2L/a/41
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3 CONTRA , AGENT
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ao State Li _e/ �J J Approve
PLUMBING INSPECTOR
11lX I URES NUMBER
UNITS FEES UNITS FEES
`%Iatcr Neate Size
iter Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
'Mash-Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sinks 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
Water Leaders Storm Drain Fee
Sprfnk let v;Jves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
.0ain Drain
Find
LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
d CITY OF CUPERTINO
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r a Sanitary i1'n.
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0 < CI. AUT
; 1961 Permit No //J �. 19 Fee $
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O Application is hereby made to the City of Cupertino for a permit to install plumbing
o < py.�r�ffic/{x-fiKhgs�M �t�i1 e reverse side hereof, and agrees to install said prices
a 1pd of fiUrrres lA�d c I h the provisions of the Plumbing Code of the City of
a w Cupertino, and all other Laws applicable
thereto. y
LL Use of PP )Sreemissess FA/ J ;jl 17
oJ Owner77i NObl�ll/9R Address /O
1 , U [ ow &zs, &4—Address2980 fTEe�,f� l/ JFK
O CONTRACTOR, AGENT
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- m Phone Zy3— -5 6 2-5
u E State License C S 7
j // 1/ < 0 7 Approved
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U PLUMBING INSPECTOR V
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer Sewer Box
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
Restaurant Sink Material
Sand Trap 'TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve SQL Gas Fee
Vac Breaker
Skimmer 5Z
Filter S
Permit Fee a-�=
Total °� Total Fee