51066 ,
LOT NO,
A 1 ION FOR PLUMBING PERMIT
X&
w z f,lAN 1$ 197/ CITY OF CUPERTINO
' 0 Sanitary No.
3 the OF ,idg4r6m 4r6Ipx�i Permit No. ,1—/0 G �i
W W Fee $
o Application is hereby made to the City of Cupertino for a permit to install plumbing
'om pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i m and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
< w Cupertino, and all other laws applicable thereto.
<
Use of Premises
g 0 /e !� 1J (tei 1 uS 1 z F'4 / PIA e d I' h a �"e
oa Owner Aj Gvave r rtt',i O
I G CO
, By AFseBMIDDL =PF1 n
ONTRACTOR.AGENTr DWOOD on.
s..
CfTY
3 < CALIF. 365-0714
— 0 Phone
a o State License- - _ ti 5 -� Approved
U • PLUMBING INSPECPOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existinit
Kitchen onn
Dish Washer
Waste Disposal Z r
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Deptal Unit
Dunkin Fountain
Floor Drain WATER SYSTEM
Hqpper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper a,
Permit Fee
Total Total Fee 3
CITY OF CUPERTINO
10300 Torre Ave.
CORRECTION NOTICE ,
FLurn�Rlm*---------------------
Department J
Job Located atW.?gA--Al-v,r-ceoec4F
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You are hereby notified that no more work shall be
done until the above violations are corrected. When
corrections have been made call the inspector.
252-4505 Date: --- -----------
City Telephone Inspector: