51187Id/fdl oL a' aAft:eC2 LOT NO. �a
NO. STREET
s�PA N FOR PLUMBING PERMIT
CUPGRTINO
s o ® Sanitary No.
x (AUG 30
�0
0 j Daie J 1968 Permit No
3`
LL %Tl 1(M� J1NO, Fee $
X ° cat rs } t7[t16Ti1,tiFe City of Cupertino for a permit to install plumbing
o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
>a and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
U)
Cupertino, and all other laws applicable thereto.
Dwelling
�. Use of Premises
00 9[
3 0 Owner Ditz Crane Company 2A0d'r De La Cruz Boulevard
ss
0a
;, Palm Plumbing Company 1�,4eale-Saratoga Rd.
J O y CONTRACTOR,AGENT
3 `m Phone 245-2323
w z
rc a 186579
0 s State License Approved i
a o
U \ PLUMBING INSPECTOR
FIXTURES I NUMBER 11 MAIN DRAIN
Water Closet 1 3— i II Material I e�
To ProD. Line
Sewer Dox
Machine
Comb.Sink&Tray I 1 11 To Curb
Floor Drain
WA'T'ER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap,
TO'T'AL FEES
Urinal
Fixture Fee
Area Thain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee a�
Total
I Total Fee 1.4.rD