51187NO.
LOT NO. b4+
!GI�;CATION' FOR PLUMBING
�Z hist �tI . UPERTINO
N 1968 ����1�J� It S'`""„ry N'
PERMIT
IS -17 v d- ,&F
Date a,ue �y�1(��'fn[, 196— Permit
Permit No.//�7
(I f1F f�krd �1�i`��d Pee$ a6 s5�<sTl
Applicatio'?is/hereby � t th ty f 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 Co,
By Palm Plumbing Co.
CONTRACTOR, AGENT
Phone 245-2323
State License 186579
R,U
�§&Pe La Cruz Blvd.
�A4'punnyvale—Saratoga Rd,
WILLIAM D. BCNEVICH
PLUMBING INSPECTOR /
�( VVV
FIXTURES NUMBER II MAIN DRAIN
UNITS I FEES UNITS FFJS
Material
Shower I / 1 II To Pran. Line 1 ✓ I I
Kitchen Sink /
Dish Washer
Waste Disposal
Wash Tray
Washin Machine
Water Softener
Bar Sink
Comb.Sink & Tray
Dental Unit
Drinkin Fountain
Floor Drain
Hopper
Restaurant Sink
Sand Trap
Urinal
Area Drain
Water Leader
Sprinkler Valve
Relief Valve
Vac Breaker
Skimmer
Filter
Total
Not Conn.
Sewer Box
STORM DRAINAGE
Size
Material
To Main Drain
To Curb
WATER SYSTEM
Size
Material
TOTAL FEES
Fixture Fee 41,11
Main Drain Fee
Storm Drain Fee
Water Sys. Fee
Gas Fee
Permit Fee
Total Fee D