51159 (6)N Q
w z
NO.
SDE
Date /-
CITY
FOR PLUMBING PERMIT
OF CUPERTINO
Sanitary No.
196_ Permit No Sew /
Pee $ /L)
Application is hereby made to the City of Cupertino for a permit to install plumbing
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
Cupertino, and all other laws applicable thereto.
Use of Premises 6i`1/`1j_-:G'//�� �i/>.'�'6
i
Owner /F/ L Cl/�" s'/"`-�'�^' Address
Sc f� l� ✓ ��n Lj�,� _3 j �y is/ i/ i s%v<-
tr��,, Address
ul CONTRAACC OR, AGENT
Phone Iy ! 3
State License / `' J-" Approved
M
PLA BING INSPECTOR
Water Heatc 1 11
Nze
Water Closets
Material
Bath Tubs
To Curb
Showers
To Prop. Line
Lavatories 5_ .� r ✓
To Existing
Kitchen Sinks
Not Conn.
Dish Washers
Sewer Boxes
Waste Disposals
TV/as -Trays
STORM DRAINAGE
Washing Machines I
Size I
ns
poppers I 1 II Size /'V I
4 G -,l
2 r -
Sprinkler ValvesWater Sys. Fee
Permit Fee
TOTAL 11 TOTAL FEE ifl. on
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final