51167.2LOT NO.
NO. 't'p`EE.T�rp
f ffCAr IOM IFOR PLUMBING PERMIT
�-- I
ITVX01' CUPERTINO
!JUN 10 1968 U Sanitary No.
Date May 27, ,, 1961 Permit No S^ 11(o 7-2—,
Q'! T V iir CIPER 100 Fee S C -'-2G, 'S --V
Application is hereby made to the Gty 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.
Ihaelling
Use of Premises
Ditz Crane Company
Owner
B Palm Pli birg Company
By CONTRACTOR,AGENT
245-2323
State License 186579
2295 De La Cruz Boulevard
Address
,Ud3,kssunnyvale-: arato€a Rd.
W iLLIAwl D. EIENBVICH
PLUMBING INSPECTOR ✓
K
FIXTURES NUMBER
UNITS FEES
Water Heater /
Water Closet
Bath Tub
Shower /
Lavatories
Kitchen ink
Dish Washer
Waste Disposal
Wash Tray
Washing Machine /
Water Softener
Bar Sink
Comb.Sink R Tray
Dental Unit
Drinking Fountain
Floor Drain
Hopper
Restaurant Sink
Sand Trap
Urinal
Area Drain
Water Leader
Sprinkler Valve
Relief Valve
Vac Breaker
Skimmer
Filter
MAIN DRAIN
UNITS FEES
Size _
Material /
To Curb
To Prop. Line
To Existing
Not Conn.
Sewer Box
STORM DRAINAGE
Size
Material
To Main Drain
To Curb
WATER SYSTEM
Size
Material
TO'T'AL FEES
Fixture Fee
Main Drain Fee y0
Stone Thain Fee
Water Sys. Fee Sw
Gas Fee
Permit Fee
Total Fee