82165 • 11449 Derbyshire Drive 9
Building Permit Confirmed ❑
Not Required Cyd
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPINJG/ PERMIT
Date---.. .._ ----- ---
19.6-`-1-. Permit --,-------
The nd igned hereby al, application to the Plumbing Inspector of the City of San Jose•,
for a permit to install plu ' t en e A n f V?7eerse side.
Exemption from requir e e a r rs License is hereby claimed
by undersigned: a owner ® statement filed ❑
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly th s this 'c io/ry/w// Y
San Jose City Business License #�� /✓ � `� �•`
I certify that in the performance of the work for which this permit is'Mtfed shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER +rh ek 7r--
ADDRESS
amADDRESS [/CS/JGtr"re, �h
� USE OF BUILDING����jK���—
L OT NO -
Signed ---------.cats -----/�/t '.."'......."--�.....
280-30
' Kirby 1149 Derbyshire Drive ✓ y
Miller II
FIXTURES FIXTURES MAIN DRAIN
Wafer Heaters or Drains Size Material
Wafer Closets Hoppers To To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size Material
Lavatories Area Drains To CurbI To Main Sewer
Kitchen Sinks Water Leaders WATER SYSTEM
Dish Washers Trailer Space Size Material —
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee
Washing Machines t Drywell Main Drain Fee '
Water Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Water SysFee
Dental Units Gas Piping Fee
.Drinking Fountains Survey
Permit Fee 2
TOTAL TOTAL FEE
Partial INSPECTOR'S REPORT HOUSE GA
RS PIPING
No. Li
Rough
� nes Outlets Size
Tested and Approved
Finish B
Y