51001.2 3 / d '-�c� ✓Ait�� LOT NO.
NO. STNEF.I'
APPLICATION FOR PLUMBING PERMIT
a CITY OF CUPERTINO
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Sanitary No. 4, / 7 2
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: a Date / / 7 Permit No. 0 0
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1967 L, � JUN � Pee $_2s-.DU
0 Application is hereby made to the City of Cupertino for a permit to install plumbing
" < pipes and/or fix s � �q e rsc side hereof, and agrees to install said rices
�` and/or(T�xTves OF c 6cElAiRhl li�provisions of the Plumbing Code of the City of
a w Cuperti}}{{o�, and all other laws applicable thereto.
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w Use of Premisese�-
00
3 Owneej -10— Address
0o By `"�(0 � � �' �Address
3 F CONTRACTOR, AGENT C
— � Phone a93—&O �7 0
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o State License �3 B 9 3�(— Approved
/ PLUMBING INSPECTOR
FI. I URhS NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Hear, /. Size ¢rr S;jp
Water Closets ,3,0-0 Material L4,
Bath Tubs y To Curb
Showers To Prop. Line
A 7—
Lavatories J� To Existing
Kitchen Sinks .SV Not Conn.
Dish Washers Sewer Boxes
Waste Disposals /7 S
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink v Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size ,eh
Restaurant Sinks Material
Sand Traps OTAL FEES
Urinals Fixture Tee 1- 0o
Area Drains Main Drain Fee 5-.00
2
\Vater Leaders Storm Drain Fee
Jprinkler Valves Water Sys. Fee 1, 5-4)
Permit Fee .pp
TOTAL
li.0011 TOTAL FEE a ,
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final