93965 825 Cottonwood Dr.
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date.:.--------------------. —Z. =�--------- 19.7L.. Permit No.------------
The undersigned h*. n
'o bi n actor of the City of San Jose
for a permit To install pi e e n e reverse side.
Exemption from rer f o a r on+rec4or's License is hereby claimed
by undersigned: o ❑ statement filed ❑
Undersigned attests that his S+e}eo{ California Contractor's License #
is in full force and effect and properly eufho/ie } 'S�pplicafi
San Jose City Business License # i 0 d.
I certify That in the performance of the 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.
OWNER /9 S D, F
ADDRESS
�ZJ CPTrOuc Oce ZSR Lot No.
USE OF BUILDING /L2
280.7e 'Signed .. 2�../�.L�C•4. :=
825 Cottonwood Drive Ace " l=bina
FIXTURES FIXTURES MAIN DRAIN
j Water Heaters Floor Drains Size Material
Water Closets Hoppers To To Septic Tank
Bath Tubs, Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size Material
ii Lavatories Area Drains To Curb To Main Sewer
Kitchen Sinks Water Leaders WATER SYSTEM
Dish Washers Trailer Space Size Material
Waste Disposals Swim Pool - LDa
FEES '
Wash Trays Indirect Wastes e_Washing Machines Drywelf in FeeWater Treat. Equip. Backflow Preventerin FeeSinks._ Survey . FeeDental Units g FeeDrinking Fountains e 2TOTALTAL FEE -3: uo
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines IOutlets Size
Rough Tested and Approved
By