849_ _ r
866 Bette Ave 1
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PEER/MIT
The undo ign�ngfi.fures
is n o:70mg ctor of the City of an Jose
for permit ins all p and/or pipes listed on the reverse side.
Exemption from requirement for State of California for Contractor's License is hereby claimed
by undersigned: as owner statement filed ❑
Undersigned attests th t his State of alifornia Contractor's License #
is in full force and affect rly autho' this pp ic''onp.
San Jose City Busin s i ens #
I certify that in th er ante of a wort fo + m s d 1 shall not employ
any person in any manner so as to violist, the workm 's compensate aws of California.
OWNER C Z Cr'1u'f7
ADDRESS K6ii 4347715%T dr Lot No.
USE OF BUILDING l2fSlO�i�lA L
2Bod0 Signed ..._ r ------
866, B.ettp Ave. . . . . . .Gr.
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