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(,1 Building Permit Confirmed
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date..... 1.-'y......................... 19..7%5-Permit No. - - ....._.. - - --
The undersigned hereb makrr.S.fner
n th �b g "tor of the City of San Jose
for a permit fo install p m n I' a h reverse side.
Exemption from raq ' men o Calif. ni for Can rector's License is hereby claimed
by undersigned: ❑ statement filed /
Undersigned attests that is State of California Contractors Pcense # 94"4Q SC
is in full force and effect a
San Jose Cit,
Business is $i /�/t"/7r/�
I certify that in the pe rma of the'w;rf for hi-cb thi Perrqft is issued I shall not employ.
any person in any manner so as to violate the works compensation laws of California.
OWNER
Lot No.
ADDRESS rte/ )
USE OF BUILDING �Qi.�mrnrdxU.
280-30(9-73) Signed
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