72357 7541 Heatherwood C Building Permit Confirmed ❑
/7 Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date -----------%A-U 19-0 Permit No... 2'7`1-----------------------
The undersigned hereby mak applicat' t Plu irlg Inspe of A City of Sen Jose
for a permit #o install plumbin f' n s I' ed o v se side.
Exemption from require mog
of �ifo fo n acicense is hereby claimed
by undersigned: - as o er ❑ statement filed ❑��_/�/
Undersigned a#tests the} his State f California Contractor's License # ILQ��-lJ
is in full force and effect and propy}OJhfei'xej llhifjpp fo,
San Jose City Business License //••�
I certify that in the performance othe work for w �
hich this permitssued I shall not employ
any person in any nar so as to viol a the orkme 's compensation laws of California.
OWNER /7 /
ADDRESS / 4�4 k6Lk t L Al
USE OF BUILDING E M AQ
g;?.RV-RLL
FORM 280-30 IOM 3/67 Si ned.... .
MATER $OFTEITT"R.FXtf2-8r-if16T-ALA-AT1ON..G '
1775 SO: IST STREET
7541 Heatherwood SAN JOSE. SerWfaUl
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size Material
Wafer Closets Hoppers To To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size Material
-ovatories Area Drains To Curb To Main Sewer
6tchen Sinks Water Leaders WATER SYSTEM
Nish Washers Trailer Space SizeMaterial
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee . D
Washing Machines Drywell Main Drain Fee
Water Treat. Equip. Backflow Preventer Storm Drain Fee
Pinks Survey Water Sys. Fee • Q u
)ental Units Gas Piping Fee
)rinking Fountains Survey
Permit Fee . Q�
TOTAL TOTAL FEE Q(/
INSPECTOR'S REPORT HOUSE GAS PIPING
'arfial No. Lines Outlets Size
lough Tested and Approved
'inish By