575 7325 Fallenleaf Lane
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE [ j BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date--- /..2-:7----X-1........................ 19.'..2.Permit No.-----a-.-57/S-------------
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install p x4 d o on the reverse side.
Exemption from r 0 ,for'rSt e afRoM r on
License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his $f a f-Califoi ce #' 5610 7 0
is in full force and effec} and pr14-7
j u{hor' /s��l irr7�/ OpC�`I/e6fido ,
San Jose City Business License # xF 0
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 to violate the workmen's compensation laws of California.
OWNER DA B l t. 'FvR D
ADDRESS 7 3 2 5 rA l L Y N L CA F L N Lot No.
USE OF BUILDING_L� �1 �� f CA L
28030 Signed---
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