72262961 Perngrove
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date _.11-113------------------------------- l91 -G,1' Permit No.....7....`..—`
The undersigned h eb s p 'on a lu i�s�ec4or of the City of San Jose
fora permit to inzial g iv asfad a reverse side.
Exemption from require ent for Stale of California for Contractor's License is hereby claimed
by undersigned: as owner C s
Undersigned attests {ha{ his $4e}a of y�j*nie C rAsia
is n y
is in full force and effect and properly a orhEs this appI tion.
San Jose City Business License # l �=
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any manner s"s to Alate !ham orkml>,compensa}ion laws of California.
OWNER
ADDRESS
USE OF BUILDING
FORM 280-30 IOM 3/67 Signed-....-------�Z�!/.Ca----------------------------------
901 Ferngrove Pince
FIXTURES
FIXTURES
MAIN DRAIN
Water Heaters
Floor Drains
Size
Material
Water Closets
Hoppers
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 I Material
_Waste Disposals
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
Water Sys. Fee
Dental Units
Gas Piping Fee
Drinking Fountains
Survey
Permit Fee
TOTAL
TOTAL FEE
_ INSPECTOR'S REPORT
Partial
Rough _
Finish F /i: •"i ,✓C�?...
HOUSE GAS PIPING
No. Lines Outlets Size
Tested and Approved
By
Al y , / i///G /L 7
`, v/^j,