51043.1 (14) aD I LOT No .lvwee W
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NO. STR
P PLUMBING PERMIT
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zi CUPERTINO
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x ° , 6$ Sanitary No
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3 < Date 196 Permit No Seo }�3.
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Fee S V Ti J V
= LL 9 SUR
° Applicai h y i tE f Cupertino for a permit to install plumbing
o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said priLC.s
> : 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.
0 n Use of Premises
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Owner �> �bF �Ui�i��/7Address
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0 CONTBy RACTOR,AGENT 5 j3tTeef
San JOse, Cal95112
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i¢ a /7/537 Approved
o State Licenser /
U 1\ PLUMBING INSPECTOR ✓
FIXTURES NUMBER MAIN DRAIN
UNIYS FEES UNrrS FEES
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen Sink d Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinkin Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Stone Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee Sv
Vac Breaker
Skimmer
Filter
Permit Fee o 1 c2—
Total
2 -Total ,S Total Fee S�