51333 i 9 A-/6 9 I LOT NO.
NO. T
0
�']] A N FOR PLUMBING PERMIT
a Y TY OF CUPERTINO
�F6 91966
x o Sanitary i\u.
oDate
a 52 P 196Permit No. f33
3 LL CITY OF CUPERTINO Pees "G
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� Application is hereby made to the 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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LL Use of Premises
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O C .'TRACTOR, AGENT
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Approve
U PLUMBING INSPECTOR
J
-FIXTURES
UNITS FEES UNITS FEES
Water Hcarc Size
Water Closets Material
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 . Sinks Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee pp
rea Drains Main Drain Fee co
�Uater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee , p n
TOTAL TOTAL FEE OCG
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final