51145 / / k I 1 x.J a,C� j LOT NO.
NO. STREET'
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
s p \ \-. Sanitary Nu.
o Date71962 Permit No `S�/ 5"S
3 5 f iYlaY 1 1367 Fee S
W LL
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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
r I and'/6rjfixtuies-in'acc6idari"�1j-u,ith the provisions of the Plumbing Code of the City of
a w Cupertino, and all other Inws ap'Flicable thereto.
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a Use of Premises
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3 Owner Ply-. (7/i ,-t, (L-x ee, Address
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O NGyT � . 1Address
R�/AGENT
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30 phone sZ 9 ,3 ��f '�✓
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a 7� 7 Approved tl 9 �
� o State License Y�
-V/d- PLUMBIN/ INSPECTOR ' /
FIXTURES
UNITS I FEES UNITS1 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
%Vas'h Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink a Trays To Curb
Dental Units
Drinking Fountains
Floor Drai s WATER SYSTEM
Hoppers,4t, s._ Size
Restaurant Sinks Material
San Tra S a TOTAL FEES
Urinals /s2 Fixture Fee _
Area Drai.nV Ile- Main rain Fee
r�Leaders Drain Fee / S,_
Sprinkler Valves Water Sys. Fee
a, ASAIIII IS-0 Per Fee
TOTAL G TOTAL FEE U D
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough, Complete
Main Drain
Final