35121 T322 FT,OWE12 Cbu�m
Building Permit Confirmed 2---�
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
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Date...... ------------------------------ 19.::7/6 Permit No.........../
The undersignedhereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plumbing fistures and/or pipes listed on the reverse side.
Exemption from requirement for State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License #�9•k—
22
is in full force and effect and properly authorizes this application.
San Jose City Business License # � n 2=-2, /S -
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 /vfiolate the workmen's compensation laws of California.
OWNER f1;A MICIA
ADDRESS 1 9- Q GQo Lot No. r U q
USE OF BUILDING �PN
M � '' n Signed .....� `.Z.x Yom..... - -... -'.....
f775t- 0 ��ve- f �- — 280-401n
S . J 1322 FLOWER COURT -PACHE� POOLS
FIXTURES N0. FEE MAIN DRAIN
Water Heaters Size Material
Water Closets To Fee
Bath Tubs RAIN WATER DRAINAGE
Showers Size IMaterial
Lavatories To IFee
Kitchen Sinks WATER SYSTEM
D6sh Washer Size Material
Waste Disposals Water Fixture Fee
Wash Trays MQSE G#S P-IPING
Washing Machines . No. Lines Outlets
Water Treat. Equip. Size bej
Sinks FEES
Dental Units Fixture Fees
Drinking Fountains Main Drain Fees
Floor Drains Storm Drain Fees
Hoppers Water S s. Fee
Sand Traps Gas Piping Fee
Urinals Surve
Area Drains Permit Fee
Water Leaders TOTAL FEE
Trailer Space INSPECTOR'S REPORT
Swim Pool I Gas Piping
Indirect Wastes Approved
Dr well B
Backflow Preventer Partial
Survey Approved
B n
Rough
TOTAL Approved
B
Finish
Approve
B