51028 (2) �40 I `"fl - LOT NO.
NO. STREET
VfAUG
FOR PLUMBING PERMIT
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°_ 2 1965Sanitary Nn.� LLS/ o - �
o a Uate 196— Permit No
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I i ah Is h City of Cupertino for a permit to install plumbing
o a 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
a w Cupertino, and all other laws applicable thereto.
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.. Use of Premises
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m �/ln�fi ,�...�t�,_ Address
0 3 Owner
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CONTRACTOR, AGENT V
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a ,f, . State License Approved
PLUMBING INSPECTOR /
FIX RNUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate f I Size " C
Water Closets 3Material
bath Tubs To Curb
Showers .� To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink a Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size If
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals I Fixture Fee /p _
A`Ir,ea Drains Main Drain Fee „2
�W
ater Leaders Storm Drain Fee
�I.rinkler Volvcs Water Sys. Fee / °y—
Permit Fee a a_
TOTAL 0 TOTAL FEE a o—
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final