83253 7524 HoLlanderry
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date..../..-- -1...,1.x....-......._.......-.. 19.�. Permit No...._—tom.1'.'.`�
The undersigned r by mak a licafion to the Plum bin Spector of the City of San Jose
for a permit to i all I d/ ist he reverse side.
Exemption fr n o a Ca if o ontractor's License is hero6y claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attesfs that his tate of California Contractor's License # -7Q r76�$
is in full force andeffect and o thorize is pp' jpny
San Jose City Business Li n erao� �
I certify that in the performance of the w.rIrfor which this permff is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER /'E,-
ADDRESS ADDRESS
USE OF BUILDING
A & J VALLLY rLu .,n.l�� °----
280-30 10-E8 Signed .............--------------------_.---------------------------..._-.....
P. 0. BOX 524 — SANTA CLARA, CALIF.
7524 HoLlanderry A & J Valley Plbg.
FIXTURES FIXTURESDRAIN
Water Heaters Floor Drains IStizeMaterialWater Closets Hoppers To Septic Tank
Bath Tubs Sand Traps DRAINAGE
Showers / Urinals Material
Lavatories Area Drains To Main Sewer
Kitchen Sinks Water Leaders YSTEM
Dish Washers Trailer Space Material d�
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee 3 a-"
Washing Machines Drywell Main Drain Fee
Wafer Treat. Equip. Backflow Prevenfer Storm Drain Fee
Sinks Survey Water Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee c,.a
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial — .( ��//� No. Lines
� Outlets Size
Rough _ _ Gam' Tested and Approved
Finish By