51126 "_ LOT NO.
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,JUN �A�PK FOR PLUMBING PERMIT
° d CITY OF CUPERTINO
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° D y_p�QPERT�NO 196`S_ Permit No
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Application is hereby made 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
nd/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Fpertino, and all of laws appli thereto.
Use of Premis
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3 OwneM- Address O V Y.J..
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a o State Licen L Approved
U PLUMBING INSPECTOR
FIXIURhS NU,%, BER MAIN
UNITS FEES UNITS FEES
Water Heate 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 . Sink a 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
Sprinkler Valves Water Sys. Fee
Permit Fee .�.
TOTAL TOTALFEE 31 U
RECORD OF INSPECTION
_Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final...