51187NO.
LOT NO, (/
FfPLUMBING
UPGRTINO
19 Sanitary Nc
PERMIT
,3-70 L 2.1
bate a �JN 12 68 Permit No !<—ii'�1
IT
Applicahtinl t lieuy nupt(-t4kT NkIf 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
Owner Ditz Crane Co, WJ6esPe La Cruz Boulevard
By Palm Plumbing Company 1A2d3�i,SS Sunrgvale—saratoga Road
CONTRACTOR, AG
Phone -245-2323
State License 186579
WILLIAM D. BENEVICH
`�y U
PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS I FEES UNITS I FF,ES
Water Closet
Material
Bath Tub
/
To Curb
Shower
/
To Prop. Line t/
Lavatories
To Existing
Kitchen Sink
/
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
To Plain 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 Ifee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee o2 .4V
Total // /� Total Fee —26S7