11329 6674 Clifford �7
7 Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING
�/PERMIT
Date------9. - / ...------------------- 19.�-// Permit No.....1.�. ........7 --
The undersigned here makes a plication to ie Plumbiyg Insp c iha City of San Jose
fora permit fo install m fi a e is a f aver side.
Exemption from re u' r e i ria o ra License is hereby claimed
by undersigned: s owner ❑ statement filed ❑a�
Undersigned attests that h' State of Califo nia Contractor's License tY
is in full force and effect and properly authorize thilicetic �' �/'
San Jose City Business License #� / �' _ a/U+�y Z �s[
1 certify that in the performance of the v�{ ich it permit is issued not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER Lll � (2Z 1 )
ADDRESS 66I Lot No.
USE OF BUILDING ked-r�
280-30(9-73) Signed ---------------------------------------------------------------
6674
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