72426 7564 sarhhart Place
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE' BUILDING DEPARTMENT
APPLIC�N FOR PLUMBING and/or GAS PIPING PERMIT
Date �f ....._---------- 191%x. Per it No. L -�-Z �...............
i
The undersigned here m e p i n o m ' g e or of the City of San Jose
for a permit to install u o i as averse side.
Exemption from re irement r $fete of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed
Undersigned attests at his State of California Contractor's License # G•r
is in full force and efV1 a operly as fi' ap it
San Jose City B n is nse
I certify that in the p ormance of the work for whit s permit is issued I shall not employ
any person in any man so as o violate toworkman's compensation laws of California.
OWNER dv
ADDRESS s
USE OF BUILDING ,Q
Signed-..-. ....�t.- ... --
FORM 280-130 10M 3\7
7564 Barnhart Place Bohm
FIXTURES FIXTURES MAIN DRAIN
Water Heaters / Floor Drains Size Material6 _'
Water Closets Hoppers To To Septic Tank
Bath Tubs Sand Traps I RAIN WATER DRAINAGE
Showers i Urinals Size Material
Lavatories Area Drains To Curb To Main Sewer
_Kitchen Sinks / Water Leaders WATER SYSTEM
Dish Washers Trailer Space Size Material
_Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee aB�
Washing Machines / Drywell Main Drain Fee o7�
Water Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Wafer Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee
TOTAL TOTAL FEE
Partial
INSPECTOR'S REPORT HOUSE GAS PIPING
—�,? No. Lines / Gullets Size
Rough �0 ,e i6 Tested and Approved
Finish �� By