73061 7639 Erin Way �.
Building Permit Confirmed
Not Required ff/
CITY OF SAN JOSE BUILDING DEPARTMENT 7 ,
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date--------------//L9 19.�16 Permit No. _...--- '7
--------_..--------
The `�• '
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undersigned her by makes appkation }o f e Pumb' g Inspector of The City of Sari, ose \ L
fora permit To ins}all I )I,/,� fix s i(,,KedJon The reverse side. .. \
Exemption from g�q�ihe�o e C do ie oor (:on}racior's License is hereby claimed
by undersigned: ��// as owner ❑ statement filed
Undersigned attests that his State of Ca ornia Cont, c}ars License �{', r Ia ,
is in full force and effect and properly euth iz /L/I is ap i � /'
San Jose City Business License e# Zj — �(_j X
I certify that in the performance of The work for which this permit is issued I shall not emplo`r
any person in any manner so- aceto viollat. the workmen's compensation laws of California. L\t L
OWNER /Us �,/»'A, a1 41
ADDRESS _�rF�_� C11a=�— e— rn
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USE OF BUILDING )
CE
FORM 280-30 IOM 3/67 Signed_.�96 Tyvj"u�p�q*BY3Tgr9 . to
San Jo-OfiWlffp 95125 r
7639 Erin Way 20QDB107 '
FIXTURES FIXTURES MAIN DRAIN
Wafer Heaters Floor Drains Size Material
Water Closets Hoppers To - To Septic Tank
Bath 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 Drywall Main Drain Fee
Wafer Treat. Equip. Backflow Preventer Storm Drain Fee
_Sinks Survey - Water Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee r-,
TOTAL TOTAL FEE —�—'---
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial
Rough No. Lines Outlets Size
Tested and Approved
Finish ,r By