51043.1 (20) 09
✓ A. LOT N
NO .
FOR PLUMBING PERMIT
" ?APR
Y OF CUPERTINO
ro 12796 Sanitary No. s6 o s
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0 a Date— �� 196 Permit No
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3�
wLLCITY QF . gq�ERTINO Fees /4117S-a
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App [taboo a er y made to the City of Cupertino for a permit to install plumbing
01 pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
i w Cupertino, and all If Is s applicable thereto.
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Use of Premises L7`
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5 3 Owner
Address
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Cir CD., 9.1r�
J By CONTRACTOR, AGENT 625 Char eSs rep
3Q � p
— < Phoneo�71J'9 San Jose, California 95112
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ao State License 1715 3 Approved
— PLUMBING INSPECTOR ��
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closet Material
Bath Tub 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&Tmy To Curb
Dental Unit
Drinkin Fountain
WATER SYSTE
Floor Drain M
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee 00 5'0
Area Drain Main Drain Fee G"
Water Leader Storm Drain Fee
Sprinkler Valve Water s.Fee S
Relief Valve Gas
Vac Breaker
Skimmer
Filter
Permit Fee
Total OO.Sd Total Fee