51107 /y�G 21 LOT NO.
NO. STREET
!AP�
�LI711I I�FOR PLUMBING PERMIT
z t � I'i'' OF CUPERTINO
0
rep,
1MAY 2) �{�I SanitaryNo.
LL �&
0 o Date 1968 Permit No 7
3 <
U Fee $ -?3-.S-6/
LL w M �'� 6lR�G�TtPf�
' 0 Ar'l cYtio i heCe t t City of Cupertino for a permit to install plumbing
0 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
<w Cupertino, and all other laws applicable thereto.
Dwelling
LL Use of Premises
00 {
3 Owner Ditz Crane Company A �S De La Cruz Boulevard
o <
zj
ByPalm Plumbing Company A �� Sunnyvale
-Saratoga R
O d,
CONTRACTOR, AGENT •�
3 < 245-2323
— N Phone
w z
0 17 State License 180579 Approved
-U PLUMBING INSPECTOR V
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater / Size
Water Closet Material C
Bath 'ub / To Curb
Shower To Prop. Line v
Lavatories 7— To Existing
Kitchen Sink / Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine / Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain blain Drain Fee ,7l
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee /S
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total 3 Total Fee ,,j`7