51043.1 (10) Zm l'O• JZ&L 4&4. AO, LOT NO.
so. STREP.
APP T PLUMBING PERMIT
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`� I�kUPERTINO
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Q 1368
o Date 196— Permit No
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LL ° Applicatic�ry`i�-�ereb��ma8p��o?EP ��I@Cupertino for a permit to install plumbing
° a pipes and/o �I ores itsted%t the reverse side hereof, and agrees to install said rices
z I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
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0 LL Use of Premises
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oa Owner�{'l� Address
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, By �I . �7 �t . Address Isis'
° CONTRACTOR, AGENT
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a o State License /S2/ Approved •�••• •�•+ -� „_.•^E{ .
U PLUMBING INSPECTOR (�
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FIXTURES NU, BER MAIN DRAIN
UNITS FEES UNITS FEES
`X/atcr Heate Size
Wate; Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
aih Trays STORM DRAINAGE
Was ing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Si— n� To Curb
Dental Units
Drinking Fountains
F'oor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
an raps TOTAL FEES
Unna s Fixture Fee
Area Drains Main Drain Fee
VV/ater Leaders Storm Drain Fee
7-pnnk1e1 valves Water Sys. Fee
Permit Fee 'e. 0
TOTAL TOTAL FEE —7 6y
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final