84432 6544 Clifford Drive
Building Permit Confirmed ❑
Not Required .—
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING
qq and/or GAS PIPING/ `PERMIT
I�— 2 J_— 19.61 Permit No.._------�. .. .7 ---------------
The
4.
Date................................ --- -- - - - ---- -- �- - -
The undersigned hereby m s p i e u I a or of the City of San Jose
for a permit to install PI by e n li e o reverse side.
Exemption from requirement for S to of California for Contractor's License is hereby claimed
by undersigned: as o ner ❑ _ at ent f' n
Undersigned attests that his State of Cif]i o c s ly./�Lff. -2 3 7 0o
is in full force and effect and properly autF glii s is ati
San Jose City Business License # 6( /
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.
OWNERIZan2lG-t,c C"Z ; N
ADDRESS y CL FFA 2� '�� Lot No.
USE OF BUILDING
28030 Aug. 69 Signed .------^ _
6544 Clifford Drive Ace PL bing Service
FIXTURES FIXTURES MAIN DRAIN
Wafer Heaters Floor Drains Size Material
Wafer Closets Hoppers To I 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 EPiping
Material
Waste Disposals iSwim PoolFEES
Wash Trays Indirect-Wastes /'00
Washing Machines Drywell Fee
Wafer Treat. Equip, Backflow Preventer Fee
Sinks Survey ee
Dental Units Fee
Drinking Fountains Survey
Permit Fee �,Gp
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING -
Partial No. Lines Outlets Size
Rough Tested and Approved
Finish By