77409 882 Brent
Building Permit Confirmed [-
Not Required ❑
CITY OF, SAN JOSE BUILDING DEPARTMENT
APPLICATION FORS PLUMBING and/or GAS PIPING PERMIT
Date....., .......l --------- 19--W Permit No.-------7 �0�--------------
The undersigned he ap 'calf i ➢lu bin a for of the,City of San Jose
fora permit fo instal as
o ipo� I' d n everzc side.
Exemption from ('PZ
for o al if rn' for Contractors License is hereby claimed
by undersigned: as owner statement filed ❑
Undersigned attests that his Siete o4 ali{o���r,,,nyyy'a Confr to s Iii ei e
is in full force and affect and properly jhf�ari�—chis ap�c�Jort/
San Jose City Business License $kms
I certify that in the performance of the work for which this permit s is ed I shall not employ
any person in any manner so as to violate the workmen's compensation —wt of California.
OWNER / ./ • %oc� 2.
'1�'ADDRESS
USE OF BUILDING_ WJCP ^
Signed.... _CL44.... .. - - -" ---- ....
FORM 280-30 10M 1/68 .
882 Brent Toepfier
FIXTURES* FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size 2 F—Material
Water Closets Hoppers To t X IS To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers / 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 0 1 Swim Pool '
FEES f
Wash Trays Indirect Wastes Fixture Fee
Washing Machines Drywell Main Drain Fee
Wafer Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Water Sys. Fee
Dental Units : Gas Piping Fee
Drinking Fountains Survey
Permit Fee
TOTAL TOTAL FEE o-
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Li Outl Size
Rough �� �� /yam �'JiU Tested and d
Finish By