51187NO.
LOT NO.
BING PERMIT
Cih^ OF QUPERTINO
JUN l.2 ts�'� 6'7o s—a�
Sanitary No
Date o .....�ta{>I" Permit No S1/�
V, Ui I( Fee$ �d,dd
Application is hereby made to the City 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.
Use of Premises
Owner Ditz Crane Co
B Palm Plumbing Company
By CONTRACTOR, AGENT
DL--- 245-2323
State License 186579
2295 De La Cruz Blvd.
Address
VASunnyvale -Saratoga Rd.
VA
Approved WILLIAM D. GENEVICF
PLUMBING INSPECTOR
J� I/
FIXTURES I NUMBER �� MAIN DRAIN
UNITS FEES UNITS FEES
Closet
Shower
To Prop. Line
Lavatories
To Existing
Kitchen Sink
(
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washin Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
'
Drinkin Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Send Trap
TO'T'AL FEES
Urinal
Fixture Fee
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
Total
Total Fee