51001.2 10478 Vista Knoll Blvd, LOT NO.
NO. STREET
AP LIC•ATION FOR PLUMBING PERMIT
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CITY OF CUPERTINO
Orr, 03 'Q97
-Date 1'221
X67 195— Permit No.
CITY Of CUPERTINO Fees;_ 50
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 a ce with the provisions of the Plumbing Code of the City of
Ir�j\ Cupertino, and othe ws applicable thereto.
se of Prem
AIL,
v
h nerJank Grlmge Address tA r"011
BR 111,1 gAn WAUt Onnel _ Address alb
CONTRACTOR, AGENT
one 736-2000 Approved /
//-PLUMANG INSPECTOR
FIXTURES-1NUMBER MAIN DRA N
UNITS I FEES UNITSFEES
Water Heater Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers
Waste Disposals ( II 1
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners S_�o I Material I
Bar Sinks To Main Drain
Comb. Sink a Traysl 1 II To Curb
Dental Units I 1 11
Drinking Fountains) 1 11
Floor Drains 1 1 l WATER SYSTEM
Hoppers I Size
Restaurant Sinks l 11 Material
Sand Traps 11 TOTAL FEES
Urinals Fixture Fee
Area .ains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Vaives Water Sys. Fee
1 1I Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final