73013 7465 Fallen Leaf
Building Permit Confirmed ❑
Not Required L&�
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date-.�../... .. 1 --7 Permit No.—,---------�..3. .L--j,--------
Tha undersigned hereby mekes application to the Plumbing Inspector of the City of San Jose
for a permit to install N b' g ' Hs / ��/y n the reverse side.
Exemption from e i o e Ino e00n{racfor's License is hereby claimed
'.^�. by undersigned: as owner ❑ isstatement filndq.
Undersigned d attests that his State of Ca' as ppjic{or's epf6��
is in full force and affect and properly eu}ho ' as applica{i
San Jose City Business License #� u 43
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 '
,r
ADDRESS94 65-
f USE OF BUILDING tali Z—pN BljcjG—SEKVrCL—
poRM aeo-Bo 10M 3/67 Signed..396 Perrymount&.C-grner.of-St-ane-Avta
San Jose, California 95125
7465 Fallen Leafy 2%blk1D7
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size Material
Water Closets Hoppers To I 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
Wafer Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Water Sys. Fee
Dental Units Gas PipingFee
Drinking Fountains Survey
Permit Fee
TOTAL TOTAL FEE
IN5PECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines
Rough Outlets Size
Tested and Approved
FinishOrBy