78006 7450 Fallen Leaf
Building Permit Confirmed ❑
Not Required Zl/
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS P—IIPING PERMIT
Date----OctobeJr...ls.. 19..68 Permit No.--- ---71
------ 0-6-e..:.
The undersigned hereby makes application to the Plumbing In�s�actor of the City of San Jose
for a permit to install plu 1 01} / pi r3494J ov kb�erse side.
Exemption from req 1r m1ni a C mi for(eoon}}e�(ors License is hereby claimed
by undersigned: s owner ❑
statement ailed ❑ 216217
Undersigned attests that his State of Calf rnia Contractor's License #is in full force and affect and properly autho z epplica}yen. n '
San Jose City Business License # f is
I certify that in the performance of the work for which this permit is issued II shall
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER A. H. Jackson
ADDRESS 7450 Fallen Leaf Ln.
USE OF BUILDING Residence
_U__L_LIGAN Water Conditioning
FORM 200.30 (REV. 3/6e1 10M Signed .. . .C_. ... ...of Los..... Gatos... .. ...
611 University Ave.
7450 Fallen Leaf Los Gatos, Calif. 95030 Culligan
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 . Trailer Space Size Material
Waste Disposals - Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee
Washing Machines - Drywell Main Drain Fee
Water Treat. Equip. .00 Backflow Preventer Storm Drain Fee
Sinks Survey Water Sys. Fee 1.00
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee 2 00
TOTAL 1.0 TOTAL FEE 4.00
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines Outlets Size
Rough Tested and Approved
Finish ,h SIX /(Y4 By