94375 855 Bubb Road
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS
�PIPING
PERMIT
Date �_,R - ---------_-- 19-7/. Permif No...... !:.( G-- ..- -
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a perm;# to install plumbing fixtures and/or pipes listed on fhe reverse side.
Exemption from requirement for State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ sfatement filed 0
Undersigned attests that his State of California Contractor's License # a 1 3 910'
is in full force and effect and properly authorizes this application. /1 l
San Jose City Business License #
I certify that in,fhe 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 / �irzze%7
ADDRESSe) " �r/` ��' Lot No.
USE OF BUILDING
Signed
28030 �' .................. .. ,C'
855 Bubb Road Steve Eachnc c ,�-•• . < .
fflTubs
TURES FIXTURES MAIN DRAIN
ers Floor Drains Size Material
ts Hoppers To To Septic Tank
Sand Traps RAIN WATER DRAINAGE
Urinals Size Material
Area Drains ' To CurTo Main Sewer
ks Water Leaders WATER SYSTEM
Dish Washers Trailer Space Size FMaterial
Waste Disposals Swim Pool FEES
Wash Trays .Indirect Wastes Fixture Fee
Washing Machines Drywell Main Drain Fee
Water Treat. Equip. Backflow Preventer Storm Drain Fee . 0
Sinks Survey Water Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains _ , •T Survey
0 (i� /Q N-� Permit Fee -.
w�4-rn.t(�' 'TOTAL TOTAL
I SP CTOR'S REPORT HOUSE GAS PIPING
Partial / _ �/ �. ' No. Lines 1,6-
Outlets Size .
Rough'/( _Zy_'7 Tested and Approved
Finish - By
�uw. ,u� oL+Mo(c .a•(•�(y n 6a "i�ZiZ�uu%r //o 9- 71AP