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® ciA771 FOR PLUMBING PERMIT
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OF CUPERTINO
tMAY 2 1968 Sanitary No.
Date /` 1968 Sanitary
Permit No --11r7
ApV O Cb��tretfelHil�f PeeS 26• -S -Z
plr ation F here y I 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
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
Dwelling
Ditz Crane Company 9�S De La Cruz Boulevard
Owner P Y A�dr s
By Palm Plumbing Company AJVTA N, Hwy 9
CONTRACTOR,AGENT
Phone 245-2323
State License 186579
Approved'-'-" -r
PLUMBING INSPECTOR ✓
FIXTURES
NUMBER
MAIN DRAIN
Dental Unit
UNITS FEES
UNITS FEES
Water Heeter
/
Size
Water Closet
WATER SYSTEM
Material L/
Bath Tub
/
To Curb
Shower
Restaurant Sink
To Prop. Line v
Lavatories
To Existing
Kitchen Sink
/
Not C
Dish Washer
Area Drain
eronn.
SewRnx
Comb.Sink & Tray
To Curb
Dental Unit
DrinkingFountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Stom Drain Fee
Sprinkler Valve
Water Sys. Fee
/, /
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total // G
Total Fee
-2G(S�