51043.1 (19) 4,'�a' ew I LOT N
NO. STR
APPL CATION FOR PLUMBING PERMIT
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_ d UPERTINO
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r o ® Sanitary No.
¢ LL Sio � 3
0 < Uate t" Permit No
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w� Pee $
0 Application is hereb Y ma e Cu ertino fora permit to install plumbing
o m pipesr and/ogYi7�i�fcs(i� 4cd � �rde hereof, and aees to install said pricc
> and/or fixtu}}�l�st 1n accQrld,ance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other
flaws applicable thereto.
LL Use of Premises /T�Lfs
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> m Owner4/�_EY
Address
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J 7 Sl D, 9.r c.
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O e r
CONTRACTOR, AGENT Char es f
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— Phone��owl San Jose, California 95112
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u f State License �'�/5'3`� Approved
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�y` U PLUMBING INSPECTOR V
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FIXTURES NUMBER= MAIN DRAIN
UNITS I FEES 11 UNITS FEES
Water Heater Size
Water Closet Material
Bath Tub I To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen Sink 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&Tra To Curb
Dental Unit
Drinkin Fountain
Floor Drain WA'T'ER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee 9-0
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee SZ
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee 1W 00
Total 76.50 Total FeG:F