96304 7526 Fallenleaf Avenue
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date...........---------------- . .- 2...-..yp 19.-?c. Permit No.------61-6 .4)�1....----......
The undersigned her makes a li }i o {he Plumbing Ins actor of }ha City of Sea Jose
for a permit to ins}all u� i lMs'E/a r pi s I' + o reverse side.
Exemption from re i e or S of or or o actor's License is hereby claimed
by undersigned. as owner ❑ statement filed ❑
Undersigned attests that his Stat�c9qqq..���JJ�� lifornia tr t r Licfnse '�µy �'3 7 20,Pis in full force and effect and propefly/a rises ` fC,
San Jose City Business License # -Z- / 0
I 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 /-7dZ-L.0 /Z y L c=,
ADDRESS -2f-'—(- FALLL tiLeAX Z- IV Lot No.
USE OF BUILDING 6,f
28030 Signed .11u.� ._�i ^r c-c ✓
7)526 Fallenleaf Avenue Ace Plumbing
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 Wafer Leaders . WATER SYSTEM
Dish Washers Trailer Space Size I Material
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee ,Cp
Washing Machines Drywell Main Drain Fee
Water Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks - Survey Water Sys. Fee
Dental Units - Gas Piping Fee
Drinking Fountains Survey
Permit Fee 2 00
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. lines Outlets Size
Rough Tested and Approved
Finish /3_ �✓/ GAI By