73689 1697 Calaway �/
Building Permit Confirmed 12
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date----------�--f- ----------------"---.- I St/C?.... Permit NO. ,�(.(Y--Gt.- ------------------------
The and rsig ned hereb makes pp1. af. to ha�Plumb' Inspector of the City of Sen Jose
for a permit to install pl r ip s �s o the reverse side.
Exemption from requiremen r S e of if rise fo onfractor's License is hereby claimed
by undersigned: as owner Q .statement iled ❑ S7
Undersigned attests that his State of a is Co r`/ m
is in full force and effect and properly a ri this K
San Jose City Business License #
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 �7L��YL�L
USE OF BUILDING.=- 1 -ll�`�
FORM 280-30 10M 3/67 Signed. --- ---C.1 "-`.`.'-" /�-----------------------
1697 Calaway Bohart
=Closets
S FIXTURES MAIN DRAIN
/ Floor Drains Size Material
`j Hoppers To To Septic Tank
i Sand Traps R N WATER DRAINAGE
/ Urinals Size Material
'� Area Drains To Curb To Main Sewer
Kitchen Sinks Water Leaders WATER SYSTEM
Dish Washers Trailer Space Size 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
links Survey Water Sys. Fee
)ental Units Gas Piping Fee
Drinking Fountains Survey
Permit Feer
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
'artial No. Lines Outlets Size
tough d n rU� y . Tested and pproved
n
'finish - Q tip i "� B
- Y