NO PERMIT NUMBER (3) LOT NO.
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/APPLICATION FOR PLUMBING PERMIT
v d ? CITY OE CUPERTINO
xo (AUG 12 196 Sanitary No.
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o Date July 196 8 Permit No
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Fee $ c
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� Application is hereby made to the City, of Cupertino for a permit to install plumbing
o 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.
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~ ~ Use of Dwelling
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� 0Owner Ditz Crane Company ?�?�� SDe La Cruz Boulevard
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, B Palm Plumbing Company �A4h,p mnyvale-Saratog4 Rd.
J O y CONTRACTOR, AGENT
3 215-2323
— m Phone
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f State License 186579 ApprovedJ{LLIAiA D. 6ZNEVICH
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—U PLUMBING INSPECTOR '/
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
,Water Closet Material
Bath Tub To Curb
Shower / To Prop. Line 4i
Lavatories To Existing
Kitchen Sink / Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Troy STORM DRAINAGE
WashingMachine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&'Ga To 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 Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee /
Vac Breaker
Skinner
Filter
Permit Fee o2
Total Total Fee o1