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80233 1040 Colony Hills Building Permit Confirmed ❑ Not Required ❑ CITY OF SAN JOSE BUILDING DEPARTMENT APPLICATION FOR PLUMBING and/or GAS PIPPING PERMIT Date ' ---------y.:..3-------------. 19-01'ermi# No.----7.....C..D... _.-73:......: The undersigned her y ekes i to Plpacior of the City of Sen Jose for a permit to ins}all hu i � � r pe a n e reverse side. ' Exemption from require a or S} a of ifo in or tractor's License is hereby claimed by undersigned: as owner ❑ 'statement filed_[cyj/�p.tel/ Undersigned attests that his Sia}e�. f Cal' ornia ContractQQr's License is in full force and effect and properl/ al�th s } ' j�� Sen Jose City Business License T�41 I certify }ha+ in the performance +he or for which this permit is isdied I shall not employ any person in any manner o as to-violate i orkmen's compensation laws of California. OWNER AN O ADDRESS OleA _' /6j USE OF BUILDING S"! J .Signed ----- - - --- ---- -- - ----- /... . . `. zeo-eo ro-ae 1040 Colonv Hills Delta talolo" FIXTURES FIXTURES MAIN DRAIN Water Heaters Floor Drains Size Material Water 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 I 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 Water Sys. Fee Dental Units Gas Piping Fee Drinking Fountains Survey Permit Fee TOTAL TOTAL FEEf, INSPECTOR'S REPORT HOUSE GAS PIPING Partial No. Lines Outlets Size Rough Tested and Approvedi, Finish By