42069 ii�S �t�sr�onv n�Yv� ,
Buildin9 Permii Confirmad�
Nof Raquired
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING. PERMIT
IDafe�Q�.45.�----.... 19.i'7. Permi# No....--...Ll'.�.t.-.°-�---,r"'-----...--�--- .
The undersigned here y mak ; ap lication 40 1 e PI bing Inspecfor of iha Cify of Sen Joso
for a permi} to ins}all u n fi dP r/�('i st d on tha rcrarse sida.
ERempflon irom r uli�fo ate of�Cali o �r Coniracior's License is herabY deim"e/d
. by undersigned: � as owner ❑ sfalemen} filed_O�L7�'L(�
Undersigned aftes}s hha! his S�ie o4 Cali4ornie Contreclor's License #
is in full {orce end effacf and prodeT�y eufhori ' e, li 1i • '—�
San Jose Cily Business Licenso/# / { � �
I terfify lhaf in the per(ormance of fhe� which fhis permit is issued I shell noT amploy
eny person in any manno/r �o(as to �iola}e ihv workmen's_coImpansefion law�s�f Cali4ornie.
OWNER � 1,�11 .�2 �� ( �"oV�S X( r�ni��-�o✓t�v. �
ADDRE55 /I� C% ��yJ ��fC'� 17�L Lo+ No.
USE OF BUILDING `5��� �<G" I�S �
, $igned .. ._. ...G�G���-' . ....---��.....`.�.............
28 0-�+�1n
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