NO PERMIT NUMBER 11bb GAKUtNb1Ut LN (( q
Building Required
Confirmed O
Not
CITY OF SAN JOSE �G pp BUILDING DEPARTMENT
APPLICATION/FOR PLUMBING and/or GAS PIPING PERMIT
Date--------------- ........... 1977 Permit No.------?---.--------------------------..
The undersigned hereby mak s applica Wit thallumbin Inspector of the City of San Jose
for a permit to install plum ' t e p the reverse side.
Exemption from requiro en to 1 o on4rector's License is hereby claimed
by undersigned: a owner ❑ statement filed ❑ �/ OA 26
Undersigned attests that his State of Ca r on4r 4or l.. aJ
is in full force and effect and properly eutha�pi'
San Jose City Business License # ���//////����``
67
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 violatetheork/men's compensation laws of California.
OWNER !� s �TA�rd/Yi77c,� /SL'ir/i"n �=
ADDRESS � $ ( 7 S'/�P x/1 . Lot No.
USE OF BUILDING
Signed ..... _..... ._.--... .--- n '----.. . .... .........
x/280-401n
1168 GARDENSIDE LN HORIZON PLBG
FIXTURES NO. FEE MAIN DRAIN
Water Heaters Size Material
Water Closets 00 To / Fee
Bath Tubs RAIN WATER DRAINAGE
Showers 1 9 09 Size Material
Lavatories 1,500 To Fee
Kitchen Sinks G WATER SYSTEM
D' Washer Size kj Material �p
Waste Disposals Water Fixture Fee (,
Wash Trays HOUSE GASP IPING
NoshingMachines No. Lines Outlets -
Water Treat. Equip. Size Fee
Sinks FEES
Dental Units Fixture Fees ®D
Drinking Fountains Main Drain Fees QJp 0
Floor Drains Storm Drain Fees •�_'
Hoppers Water S s. Fee d d
Sand Traps Gas Piping Fee '0
Urinals Survey
Area Drains Permit Fee p
Water Leaders TOTAL FEE 8
Trailer Space INSPECTOR'S REPORT
Swim Pool Gas Piping _
Indirect Wastes Approved — d y
Dr well By kLl�
Backflow Preventerl Partial
iurvey Approved .Z 7
'Rough
TOTAL 49.oO Approve 0.77
(/Gs St d r ts .c0�.
o ` —r Finish !/
C 2— —7 7 3i 4REKed _ 7
y b 7 B