5100810382 I Meadow Place LOT NO.
.-r•PIO� �'�-_a C,\ST'RSET� -
APPLICATI FOR PLUMBING PERMIT
nl ;3 ����C(;'!"iOF CUPERTINOi
D691b , P--, 14� Permit No. 3 1 O
`' ` ''a vi
Fee $ 3.50
C
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
1 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
.-a
Owner 1,51 Address l0611;2-
By & - &=g xJ A Address M02 47•
U CONTRACTOR, AGENT /_ /
Phone lfn - ! Approved L.y
PLUMBING INSPECTOR / �C
i
FIXTURES I NUMBER 11 MAIN DRAIN
UNITS
FEES
UNITS
FEES
Water Heater l
��
Size l
l
Water Closets
Material
Bath Tubs
To Curb
Showers
To Prop. Line
Lavatories i
ll
To Existing l
l
Kitchen Sinks
Not Coon. I
l
Dish Washers l
ll
Waste Disposals
Wash Trays
STORM DRAINAGE
Washing Machines
I
I II
Size
Water Softeners
Material
I
Bar Sinks
To Main Drain l
l
Comb. Sink & Traysl
l 11
To Curb
Dental Units
l
l ll
l
Drinking Fountains)
l II
l
Floor Drains
l
l ��
WATER SYSTEM
Hoppers
l
l ll
Size l l
Restaurant Sinks
l
l ll
Material l l
Sand Traps
TOTAL FEES
Urinals
l
l ll
Fixture Fee
l
Area Drains
Main Drain Fee
l
Water Leaders
l
l ll
Storm Drain Fee
l
Sprinkler Vaives
l
l ll
Water Sys. Fee
l
l
l ll
Permit Fee
TOTAL
l
l ll
TOTAL FEE ,
RECORD OF INSPECTION
Partial Rough
Rough Complete
Final