14929 M616 Cleo
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPIN9G PERMIT
Date----- --
/------�---------- 19 Permit No.------./�<-- ------------
The undersigned he b mak s applicatio to the Plum bin spector of the City of San Jose
for a permit to Inst n _r` s`! ste he reverse side.
Exemption frog or $6 is o ontractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of C fornia Contractor's License #
is in full force and effect and ro erl eut n o a li on
`San Jose City Business Licensee#y . p;I //•/r/ �-"—
I certify that in the performance of the work for which this permit is issued shall not employ
any.person in any manner so as to violate the workmen's compensation laws of California.
OWNER
ADDRESS �h Olt r � Lot No.
USE OF BUILDING ALA
280-30(9-73) Signed.......... ---
20610 Cleo Apache Underground
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