42070 7Ml VOLKEST691E SRTVE
Building Permit Confirmed
Not Required
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
G
Date.. U�r ----------- ........ 197(... Permit No......... - .... ..........................
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plumbing fixtures 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 ❑� • .� l�,
Undersigned attests that his State of California Contractor's License #— 21 2 y
is in full force and effect and properly author}his e � nZ
San Jose City Business License #
I certify that in A0 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 compensati�o�laws of California.
OWNER — 1701//J42! l �u/S Urrvi`C (GYI '
ADDRESS 79 Z 7 F��C Ps��L� T� k2- Lot No.
17
USE OF BUILDING �It L �
Signed .. _ .Gf!Lkr ..--...... -
.--- p----
7QF7 TVnT.KF.CTf1TTF. T)RTVF, LOUIS J- Paf8l�ONTF
FIXTURES NO. FEE MAIN DRAIN
Water Heaters Size Material
Water Closets To IFee
Bath Tubs f RAIN WATER DRAINAGE
Showers C Size Material
Lavatories To Fee
Kitchen Sinks WATER SYSTEM
D' Washer Size Material
Waste Dis orals Water Fixture Fee
Wash Tra s HOUSE GASP IPING
WashingMachines No. Lines Outlets
Water Treat. Equip. . F
Sinks FEES
Dental Units Fixture Fees
Drinking Fountains `r Main Drain Fees
Floor Drains Storm Drain Fees
Hoppers W Water Sys. Fee
Sand Traps s Gas Piping Fee vro
Urinals .Surve
Area Drains Permit Fee
Water Leaders TOTAL FEE I S0-0
Trailer Space I ' REPORT
.Swim Pool �Gas.Pi
Indirect Wastes e ,29
Drywall n;1.
Backflow Preventer s Partial
Survey / Approved
117 B
i� Rough
TOTAL AVpproved
A. 4. M By
-/ s- Finish
i.&:)n Lz Approved
B