79021 7551 Heatherwood g
Building Permit Confirmed ❑
Not Required Iv
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPIIN�G PERMIT
Date ,, e, --��....--------------- 4` ,/- 19Permi+ No.------------.L--- - -I----
The undersigned here in I . ' n to P 'Pun,u Inspector re or of theside.City of San Jose
(ora permit to install /or i s the reverse side.
Exemption from re or a Iii on}racfor's License is hereby claimed
by undersigned: as owner ❑ statement filed �]_q7
Undersigned attests that his Stat f C4{ornie Contractor's License # i
is in full force and affect and props; P5oi l' eli l
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
USE OF BUILDING
FORM 280-30 10M I/68
7552 Heatherwood Ace
FIXTURES FIXTURES MAIN DRAIN
Wafer Heaters Floor Drains Size Material
Water Closets Hoppers To To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size Material
Lavatories 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
Sinks Survey Water Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines Outlets Size
Rough Tested and Approved
Finish U� cf�tf�,�gr .� By