73689 1661 Calaway /
Building Permit Confirmed LTJ
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
• Date----'-/- -- --"-'-------------------... No./5-69.7 19ff.. Permr# - ---------------------
The un/ dersigned her makes applica}ion to the Plumbing In cfor of the City of San Jose
for a permit to insiell u q ¢ d ip o reverse side.
Exemption from i rn' or o <far's License is hereby claimed
by undersigned: as owner ❑ statem¢nt filed ❑
Undersigned attests that his State of California Contractor's LLicense #
is in full force end effect and profll —rimes •s p a'' —�
San Jose City Busin¢ss Licens ����
1 certify that in the performance of the work for which this permit is issued I shall not employ
any person in any manner rss�oas//to violate the workmen's compensation laws of California.
OWNER /�• �f�! �lni`SY�o�I/�fi•
ADDRESS /642 �iiU ii Ali/ / te�L
USE OF BUILDING .l c
FORM 260-30 10M 3/67 Signed ......................
1661 Ciaway Bohart
FIXTURES FIXTURES MAIN DRAIN
Wafer Heaters Floor Drains Size Material
Water Closets Hoppers To r! ' To Septic Tank
Bath Tubs / Sand Traps RICIN WATER DRAINAGE
Showers / Urinals Size Material
Lavatories ,f' 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 zy+
Washing Machines Drywell Main Drain FeeC�
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 / HOUSE GAS PIPING
'artial - 71 7•i/,� S,�„; „ �, ., - i No. Lines Outlets Siz
tough _ .i. 4' ,• J ` i �,�,. Tested and Approved -�� f P,
_wish -1 Fi(� .CC'_ / By cL