70623 1383 01ifford
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATIONS / FOR PLUMBING and/or GAS PIPING PERMIT TS
Date....;F---=- —'F. -2------------- 19------- Permit No.-------1-7-0-6-Z-7
7-0GX. 3
Tha undersigned heresy- a es I' +i o Jb�e(yI m Jig)Inspector of the City of San Jose
for a permit to ins}alliQfug /_ the reverse side.
Exemption from re a se for State of ahfornie for on}rac}or's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑/�/' 2
Undersigned attests }hat his Sfa+e>qf C ifornia Contrac+o..'s License 7 7
is in full force and effect and propsprires
San Jose City Business License �
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any man as viola}e the wo :en's coWensa+ion laws of California.
OWNER L^=�� " 09
ADDRESS / 3 c 3
USE OF BUILDING
FORM 280-30 IOM 3/67 Signed--------- --- -- -- --------------------------....
1383 9japark Clifford P-krce
FIXTURES FIXTURES MAIN DRAIN
_Wafer Heaters Floor Drains Size TMaterial
Wafer Closets Hoppers To 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 Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee
Washing Machines Drywell Main Drain Fee
Water Treat. Equip, Backflow Preventer Storm Drain Fee
Sinks Survey Wafer Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee
TOTAL TOTAL FEE •�J
INSPECTOR'S REPORT HOUSE GAS PIPING
PO�1O�-' No. Lines Outlets Size
Rough Tested and Approved
Finish , Byl
/V,