4593 6087 Bollinget Rd
Building Permit Confirmed ❑
Not Required 9—
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
1&9 — 73
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Date--------------------------------------------- 19 --- Permit No......-.....4 --J�---- '..---...---...-----
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plumbing fixtures 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 0� Q� `3,,
Undersigned attests that his State of Califoinia Contractor's License #
is in full force and affect and properly authorizes this application.
San Jose City Business License # yW — O/ 3 �/
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER ��C2wrrt
� D Lot No.
ADDRESS
USE OF BUILDING /Z FS
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6087 Bollinger Rd V Ace
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