91623 1104 Elmsford
Building Permit Confirmed-Crl
--�
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLI ATION FOR PLUMBING and/or GAS PIPING PERMIT
I Date---
/ 19.7/.. Permit No. -Y&. 7
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Then sby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plu bing fixtures nd/or,pipas I' ed on the reverse side.
Exemption from req Ribbing
t o a r Contractor's License i hereby claimed
by undersigned: r staiemont filed 't_1
Undersigned attests that h' Stato of California Contractor's License
is in full force and effect and properly author ih's/p I' ti n• /
San Jose City Business License #' `f
I certify Aat in the performan a of th�f whit this permit is i sued I shall not employ
any person in any me a so as violate the workmen's compensation laws of California.
OWNER "
ADDRESS // O Lot No.
USE OF BUILDING
78040
Signed ..... - - -
i
G .
1104 Elmsford Sunset Associates
FIXTURES FIXTURES IMAIN DRAIN
Water Heaters Floor Drains Size Material
Water Closets Hoppers To To Septic Tank
'Both 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 Material
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee
Washing Machines Drywell Main Drain Fee
Water Treat. Equip. t/ Backflow Preventer Storm Drain Fee
Sinks Survey Water Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PI ING "
Partial -� - 7 No. Lines
Rough Outlets Size
Finish Tested and Approv d
By .