51167.2 (2)F, �� �. 1I
H.
Al S4
I FOR PLUMBING PERMIT
" d I, OP CUPERTINO
w a IMAY 131968 sanitary No.
Y °
o a Date Y 62 (1 [pT p 1968 Permit No 4-116 -7,7-
50
7,. �
i LL WY 1 COPERT I �il� Fee $ o��o. S?i
° Application is hereby made to f e City of Cupertino for a permit to install plumbing
o w 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
a w Cupertino, and all other laws applicable thereto.
w x
LL Use of Premises Dwelling
o0
3 Owner Ditz Crane Co, 22cge5De La Curz Boulevard
° G
, B Palm Plumbing Co. ]AUO. Hwy 9
J ° y CONTRACTOR, AGENT
3`245-2323
— 0 Phone
w w WILLI-r'M D. :d=✓:C 1
rc a State License 146579 Approved
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0 PLUMBING INSPECTOR V
FIXTURES
NUMBER
MAIN DRAIN
UNITS I FEES
UNITS FEES
Water HeaterI
IlSize
Water Closet
1-4
Materiel
Bath Tub
I To Curb
Shower
/
To Prop. Line ✓
Lavatories
To Existing
Kitchen Sink
Not Conn.
Dish Washer
$ewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & TrayTo
Curb
Dental Unit
Drinkin Fountain
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
S rinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee ,
Total
Total Fee