51001.2 1D:XZGL (/,L Ji�/ ��/L��+- LOT NO.
NO. STREET
YFEB��LC FOR PLUMBING PERMIT
C OF CUPERTINO
2 ��g /pDate IR32� Permit No. -> i0 O/ �.F Cl,IPERTlP,10 Fee $
Application is hereby made to the City of Cupertino for a permit to install plumbing
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
Cupertino, and all other laws applicable thereto.
Use of Premises
Owner Address A/) op
B Address �D
CONTRACTOR, AGENT
Phone �'�s��-a-"fJ T
Approved
1C1 PLUMBING INSPECTOR
FIXTUR NUMBER 11 MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater I Size
Water C osets Material
Bath Tubs I To Curb
Showers To Prop. Line
Lavatories-I I II To Existing I I
Kitchen Sinks I 1 II Not Conn.
Dish Washers I 1 II 1I
Waste Disposals I 1 II I
Wash Trays I 1 II STORM DRAINAGE
Washing Machines Size
Water Softeners 11 Material
Bar Sinks To Main Drain
Comb. Sink x Traysl I II To Curb I I
Dental Units I 1 11 I
Drinking Fountainsl 1 II
Floor Drains I I II WATER SYSTEM
-ff-opp,ml 1 II Size II
Restaurant Sinks I Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area Drains I I II Main Drain Fee
Water Leaders I I II Storm Drain Fee
sprinkler Va vw s I I Water Sys. Fee
I Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final