51119 (2) �OoC 7lz I LOT NO.
NO. STREET
J& T FOR PLUMBING PERMIT
z a D OF CUPERTINO
R 1JU0 Sanitary No.
,,MAR 2 9 y
0 a Date 196_ Permit No
3 � p�err
w LL ��TY 0FP &TQ Fee $
o
� c ho h t 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
> 1- and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all orb r laws applicable t ereto.
LL Use of Premises
00
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r 3 Owner Address .�
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J z By Address
O ,^,CSR�NTRACTOR, AGEM
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Phone lCX 2 z,3 3
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0 s State License Approved
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U I PLUMBING INSPECTOR
HXTURES NUMBER MAIN DRAIN
UNITS I FEES UNITSI FEES
Water Heate ,00 11 Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
is Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sin t s rays To Curb
Dental Units
Drin mg Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San raps TOTAL FEES
rivals Fixture Fee
Y��r�ea rains Main Drain Fee
W Ater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee ' ,ev
TOTAL TOTAL FEE jF�.
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final