21082 874 E. ESTATES DRIVE
j Building Permit Confirmed ❑
x Not Required ❑
CITY OF SAN JOSE J BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
_
Date---------w"--�-----...---lc_....------------- 19k4n.y. Permit No.---------Z-1�-�/-'-7i---------.......
The undersigned hereby m kes application to a P 'ng In r of +he Ci of.Sen Jose
for a permit }o install plu in i r n o e izf n r arse side.
Exemption from requi ate ai or is or onir or'z License,is hereby claimed
by undersigned: as wner ❑ statement filed Q} �O- - 3
Undersigned of}effz that his fare of Cali hie o star's icensa #��
is in full force and effect and properly author' a } a li to lGA((!/�
San Jose City Business License #'
c
I certify that in the performance of the work for which this permit is issued I she noT employ
any parson in any manner so as to viola}e the workmen's compansa}ion laws of California.
OWNER fl7�t D
E74 E � rff 72':-9OR , Lot No.
ADDRESS �,
USE OF BUILDING M p£
S - Q
280-30 Signed-....X: --
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874 E. ESTATES DRIVE CUPERTIN02IL$G:
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