34423 7864 BELXNAP DRIVE
Building Permit Confirmed
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
3
Date-------------- ....___ ... - - 19 . .. if - - - .....
The undersigns or c c n e PI in 1 e Cify of San Jose
for a permit to Inst plum i tures a o pipes , d on the reverse side.
Exemption from requireme for State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement'filed ❑
Undersigned at sts that his State of alifornia Co ra for' License oC y7 3.7 3
is in full force en a fec Sher erly 'Fe is ca
San Jose Ci B i ss ,cent #
I certify fh n f e riormenca of Aj.ork for which this perm' is issued I shall not employ
any person ,n eny manner so as to violate the workmen's compensation laws of California. O/�
OWNER
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ADDRESS ���y—��� �/¢� %�� Lot No.
USE OF BUILDING 1
Signed l--/--�QQ--- '- ----- - ----22--gg..��..-----......
7864 BELKNAP DRIVE
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