51001.2 (2) IV/S1n`I •C•NO GC 194 LOT NO.
NO. STREET
{r. APPLI ATION�'FQR PLUMBING PERMIT
CI`I�Y I�fUPLRTINO
srcQUV LI ; Sanita ry No.
4
61
3 a Date T /� I� 196— Permit No S /C'O /• Z
F o rl F.Y l'1 1��1P�®®r1.110 Fee S
Application is hereby made to the City of Cupertino for a permit to Install plumbing
'o a 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
a w Cupertino, and all other Taws applicable thereto.
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CONTRACTOR, AGENT (/
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apo' State License a -� 8 9 3•S� Approved.n. . .....
r PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNrrsj FEES
'Plater Heatc / Size
Water Closets Material /
Bath Tubs / To Curb
Showers To Prop. Lin too
Lavatories To Existing
Kitchen Si / Not Conn.
ish Washers Sewer Boxes
Waste Disposal
as'h Trays STORM DRAINAGE
Washing g Machines / Size
Water Softeners / Material
Bar Sinks To Main Drain
Com . Sinksrays To Curb
Dental Units /a-b
Drin ing Fountains
I oor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material 6*CV / /aa
Sand Traps TOTAL FEES
Urinals Fixture Fee o u
rea rams Mai Drain Pee �{", oe
Vater Leaders 'n Fee
Sprinl:ler Valves
Water Sys. Fee
Permit Fee
TOTAL /z 1,Ce, TOTAL FEE - o
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final