18773 -6b75-CLIFFORD DRIVE
r Building Permit Confirmed ❑
Not Required E
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
/ 4k.773
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Date---l...�....�-------................ 19.Z�_ Permi# No...._C„r7 6--/-------------------
The undersigned hereb ekes epplicatio to the Plumbing Ins of the Ci}y of Sen Jose
for a permit }o install pl s I e i se side.
Exemption from requi f e s License is hereby claimed
by undersigned: statement filed ❑
Undersigned d attests ��nliforrlnia �jtpn}r�€?or's License ���
is in full force end effect and properly authorizes }h'/dgllp ica�{ion.
San Jose City Business License #
I certify that in the performance of the work for which this permit is issued I shell not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER /Y l L- k- k A L-L_ t=R
ADDRESS D R . Lot No. .
USE OF BUILDING RES
280-30(9-13) Signed
6675 CLIFFORD DRIVE OWNER
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