85216 1177Elmsford Court
I
Building Permit Confirmed [a--"No+ Required El
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date-/-- --- -----------.--------------- - Permit No--------- ��.. ��2------------
The undersigned hereby ma�n_applica+ion +o t e Plumbing I ctor of +he City of San Jose
for a permit to install plumb i Afixryr n es isfddreverse side.
Exemption from requirem�Yttrr e o ali ie for Contra License is hereby claimed
by undersigned: as ner statement filed ❑
Undersigned attests that his State of a rpsa Co n. i
is in full force and effect and properly au r'�s�#his p c i6Y
San Jose City Business License #y9 — O /a/ 9
1 certify that in the performance of the work for which this permit is issued I shall not employ
any person in any manner so as fo la+ the workman's compensation laws of California.
OWNER
ADDRESS -//
USE OF BUILDING e NO, --
A & J VALLEY P
200.30 10-60 Signed- ---------------------------------------------------------
p, Q. BOX 524 - SAPITA CLARA, CAL .
1177 Elmsford Court A&J Vallev
FIXTURES XTURES MAIN DRAIN
Wafer Heaters Floor Drains Size 11 Material (' /
Water Closets Hoppers To I To Septic Tank
Bath Tub's 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 SizeMaterial
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee r —
Washing Machines Drywell Main Drain Fee —
Water Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Water Sys. Fee /
Dental Units Gas Piping Fee a
Drinking Fountains Survey. ..
Permit Fee '
TOTAL TOTAL FEE xflZ?--I
INSPECT R`S REPORT
Partial Z 3 Jo HOUSE GAS PIPING
Rou h _ A7�/ �G No. Lines Outlets Size 3_�_
Finish
Tested and Approved
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