21128 7895 FIESTA LANE
Building Permit Confirmed
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR- PLUMBING and/or GAS PIPING PERMIT
zl-� 7=----- -
Da#e-------- -- --- - - - -------- 19L.-fes-Permit No.------------- - ------
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plum � r pipes' •sf9V }he reverse side.
Exemption from regwremen for S 1 o Girdo i o nlracfor's License is hereby claimed
by undersigned: as owner ❑ statement filed 0
Undersigned attests that his State of Ce b�,'�=Contr�ggAtor i ns
is in full force and effect and properly authu�i.2e h. ap o;ti,
San Jose City Business License #'—
I-
' ���3�✓(/
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
ADDRESS ��� �51Tia LAi✓E Lot No
USE OF BUILDING S/NGC ! 64*
280-30(9-73) Signed y4'7lfZf./ (2'- -----7rT.. e:-s------------"------
79q.5 'FIESTA LANE 4 •ADMIRAL POOLS
FIXTURES NO. FEEI AIN
Nater Heaters ° �� I Size IMaterial
Water Closets To I Fee
Bath Tubs RAIN WATER DRAINAGE
Showers Size iMalerial
Lavatories To Fee
Itchen Sinks WATER SYSTEM
Dish Wgsher Size Material
Waste Disposals Water Fixture Fee
Nash Trays HOUSE GAS PIPING
Yashing Machines No. Lines I Outlets
Nater Treat. Equip. Size j Y y ltee
Sinks FEES
Dental Units Fixture Fees
Drinking Fountains Main Drain Fees
Floor Drains Storm Drain Fees
Hoppers Water Sys. Fee
Sand Traps Gas Piping Fee
Urinals Survey
Area Drains Permit Fee O
Water Leaders TO AL FEE
Trailer Space INSPECTOR'S REPORT
Swim Pool Gas Piping
Indirect Wastes Ap rov d ,�Z.7
)rwell B wz
3ackflow Preventer Partial
iurvey Approved /Q
B
Rough
TOTAL Approved '
B
Finish
Approve
B �iP Gus