51167.2 (2)LOT NO.j /
NO. STREET
APPLICATION FOR PLUMBING PERMIT
d I Y OF CUPERTIN0
r a Sanitary No.
11�8—// 7 L
0' Date I Permit No
3 u JUN Zb Wbb W Eee $
x LL
O Application is hereby made to the City of Cupertino for a permit to install plumbing
`o pipes a� fi�c�q�es ��Y�� terse side hereof, and agrees to install said rices
r r and/or4txPu�es hi �acc�htta5iceLd�fth` provisions of the Plumbing Code of the City of
Q w Cupertino, and all other laws applicable thereto.
wi
j Use of Premises Dwelling
00 2295 De La Cruz Boulevard
r 3 Owner Ditz Crane COm _ Address
oL B Palm Plumbing Compny 12434 Sunnyvale-Saratoga Rd,
J ress
O y ONT�cn(.-TOR, AGENT
3 0 Phone 245 SJ
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State License 185579 Approved
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�-- 0 `/ PLUMBING INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Fleeter
Size
Water Closet
Material
Bath Tub
/
To Curb
Shower
/
To Prop. Line
Lavatories
To Existing
Kitchen Sink
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Mazerial
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 12,06
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
S rinkler Valve
Water Sys. Fee
Relief Valve
I Gas Fee ory
Vac Breaker
Skimmer
Filter
Permit Fee G-0
Total
Total Fee-'n;-;$0