140727471 Bollinger rd.
CITY OF SAN JOSE I
Building Permit Confirmed ice"
Not Required ❑
BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Da+e....'./J. /J
7 ��a.---------- ..............._--- 19.7�ermif No. _.._.-' ("O. -_.---------------------
The undersigned hereby mak�ss application o e lu n,,y�/��� actor of }he City of San Jose
for a permit to install plumbir�� ri r I n / e /N ✓- reverse side.
Exemption from requirem�V /;N , a of iforma for Contractor's License is hereby claimed
by undersigned: as ofler ❑ statement filed ❑
Undersigned attests that his State of C ifornia Contractor's License # '-zl?-2.�.3��
is in full force and effect and properly euthl is ap /r—' �V,,///
San Jose City Business License # z Q o1_64 .
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 /l9//29 i5117) /Y9&U-/J
ADDRESS 7171 Lot No. G
USE OF BUILDING k —
280-30 (9-13) Signed,Q CL7 ----' ° -s .....................-
7471 Bollinger rd. apache
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