51102 VQ�J �`/LjpT NO.
VAPR
�LefT FOR PLUMBING PERMIT
aX11 C OP CUPERTINO
X ��7S0 Sanitar No.° 131965 s0LLJWez
o < Uate 196_ Permit Nn
3a Q
i LL � (� [p (� Pee $ ��/• OI
'- 0 g1,IiFatiDFi1 t�ksRTINQ, City of Cupertino for a permit to install plumbing
`o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
iand/or fixtures in accordance with the provisions of the Plumbing Code of the City o
a w Cupertino, and all other laws applicable thereto.
�. Use of Premises S�ip�//ems Symr-i1lt/
00
o < Owner Address
B �'�-41d�l✓rOltr �r.�
Jo
y CONTRACTOR, AGENT Addres
Phone
a o State Lice �,
2�» p Approved
U _ PLUMBING INSPECTOR
FIXTURES NUMBER
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material e',
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
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks MaterialdW VON
TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee OQ
Water Leaders Storm Drain Fee
k s Water Sys. Fee ,Q
Permit Fee 00
TOTAL 14101TOTAL FEE ,0
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
X4ain Drain
Final