100057 2Qj#/ ✓ANW.-Ow ~ L/40• LOT NO.
NO. STREEI'
® SAP. LIT FOR PLUMBING PERMIT
z Y OF CUPERTINO
r ° INOV 5 1965 t sanitary No. �� '? �
p LL
OQ Uate 196— Permit No. /00
3 u Pee Sr
0111 ,LA� at n is b} c to City of
Cupertino for a permit to install Plumbing
o 1 pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r 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.
w x
� r
LL Use of Premises
00
0 3 Owne �✓• �N1SD.tJ Addresswip
J
0 6y ���`'�C C�jf/Qi Address /v
3 F C0NTRACT03�x�'GV T
— `0 Phone
rca � 6//0!?[
a o State License Approve
UI/ PLUMBING INSPECTOR
1) D BER MAIN DRAIN
UNITS FEES UNITSI FEES
Water Heate Size /i
Water Closets Material -L—
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
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Arca Drains Main Drain Fee 112 011�—
Water Leaders Storm Drain Fee
�-p 1n0 1 Valves Water Sys. Fee
Permit Fee c
TOTAL I TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final