30475 1168 GA121�r N5Y>3 YANG
Building Permit Confirmed-0—
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date.........�/.;��sl.�t. ............. .. 19. J Permit No.,...--- D"` �S_----------
The undersigned here m k s p licafion t the Plumbing Inspector of the City of San Jose
for a permit to install i e / d fT ' on the reverse side.
Exemption from re r or e o r Contra.+or's License is hereby claimed
by undersigned: as owner ❑ statement filed /p
Undersigned attests that hisproperly SPafay 1�C�lifornia on JIFCIpsy# r��
is in full force and effect and ro erl a /ries +' r1d�•
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 ���� ¢i»'aistc� /�-� S7Lo+ No.
USE OF BUILDING
Signed.... .,rmr�...-- --�1� .��y ------..�....
'4;� 401n
1168 GARDENSIDE LANE HORIZON�PlIIMIATKIr_
FIXTURES N0. FEE MAIN DRAIN
Water Heaters !c7/ Size IMaterial
Water Closets To IFee
Bath Tubs RAIN WATER DRAINAGE
Showers SizeMaterial
Lavatories To Fee
Kitchen Sinks WATER SYSTEM
Dish Washer SizeMaterial
Waste Disposals Water Fixture Fee
Wash Trays HOUSE GASP[PING
Washing Machines No. Lines Outlets
Water Treat. Equip. Size Fee
Sinks FEES
Dental Units Fixture Fees
Drinking Fountains Main Drain Fees
Floor Drains Storm Drain Fees
Hoppers Water Sys. Fee
Sand Traps as Piping Fee
Urinals Survey
Area Drains Permit Fee
Water Leaders TOTAL FEE 3
Trailer Space INSPECTOR'S REPORT
Swim Pool Gas Piping
Indirect Wastes Approved
Dr well B
Backflow Preventer Partial
Survey Approved
B
Rough
TOTAL I Approved
-
By
Finish
ApPrOVSA �}
B