36231 901 COTTONWOOD DR �^
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPINGPERMIT
Date........................... `- - 100 ' Permit No.----- G /------- ---
The undersignedherebPas .K.nE-]
' tion +y th bing Inspector of the City of San Jose
fore permit fo instal pl I' ed on the reverse side:'
Exemption from 4 alt or a For Contractor's License is hereby claimed
by undersigned: er statement (fled ❑
Undersigned attests that his a+a of California Contractor's License # 1
is in full force end of{act and pr erh..a,ut�r�es p'E io p
San
Jose
City Business Lice
I certify that in the performance of the work for which this permit '(issued I shall not employ
any person in any manner so as tovviolate the workmen's compensation laws of California.
OWNER
ADDRESS 96V 6' .a-G✓�/�iA �it of No.
USE OF BUILDING y2e-s
-'
/... 7C:n-----------___...
Signed-/Q1 .
l`J O 0ln
901 COTTONWOOD DR ILLS PdQ 4.
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