19654862 ferngrove drive
A Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PJIPING PERMIT
Date---.. L...-� lJr---//----�........------ I�lc.. Permit No - -------- L /e6r "5-4 ----------------------------------
The undersigned hereby a .s a/r PQ spec#or of the City of San Jose
for a permit to ins}all plu s i s is }ha reverse side.
Exemption from requirement f r State of/El ifornia for Contractor's License is hereby claimed
by undersigned: as owner ❑� �� f, Je�l929 4. �
Undersigned attests that his State of Cvei/•iTo Con#rac#ors Lice (/�p'L
is in full force and effect and properly authorizes this application.
San Jose City Business License
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 Ua�L_0
ADDRESS _34o� &JI_ -=h j4L
USE OF BUILDINGS S_
280-30 (9-73) Signed
862 Ferngrove Drive
Lot No.
f�C� Ace Plbg.
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