793157373 Fallen Leaf
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date ----------- -------I ---- ---%----3--I--- I9-0- Permit No.------- 1- --------
The undersigned hereby makes applililion +o +he Plumbing Inspector of the City of San Jose
{ora permit to instal ,%�,g/ r n �/�ip sed on the reverse side. '
Exemption from r Q efik�. a afL r for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ _
Undersigned attests that his State f California Contractor's License # 21 b fo 2
is in full force and effect and pro erl a xes this li at /
San Jose City Business Licensee#�%y-s'✓% �1
I certify that in the performance of the work for which this perm is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER <-nAn <a
ADDRESS i3 =n k s�1 LBA? f.,1 rJ S S.
USE OF BUILDING CA- rZ'iAe1�-Y'
--.t3a-. �----OC,-- --C---�---�---------
2Bo-30 10-ae Signed --------- - ---
7373 Fallen Leaf Lane naKin
FIXTURES
FIXTURES
MAIN DRAIN
Water 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
-Disposals
Trailer Space
Size Material
Wast
Swim Pool
FEES
Wash Trays
Indirect'Wastes
Fixture Fee
Washing Machines
Drywell
Main Drain Fee -
Water Treat. Equip.
Backflow Preventer
Storm Drain Fee
Sinks
Survey
Wafer Sys. Fee
Dental Units
Gas Piping Fee
Drinking Fountains
Survey '
r
Permit Fee `L
TOTAL
INSPECTOR'S REPORT
Partial
Rough
TOTAL FEEO
HOUSE GAS PIPING
No. Lines , Outlets Size /
Tesfed and Aooroved