22635 7 562 I-tOY,YANi3E13ftY
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPL/I,CATIO�7N FOR PLUM ING and/or GAS PIPING PERMIT
Date -!�L- -)/-------- -- ------. Ir%L.. Permit No.._ -V --- ------------
Th.
-- ..
Tha unrJ agned hereb akes a lie 'on the Plumbing Ins dor of 4ha Cit y of San Jose
for a permit }o install hi
mb' r fe on ersc side.
Exemption from re fa e f a i r ' o� c or's License is hereby claimed
by undersigned: sr owner ❑ statement filed
Undersigned attests that his State o^fr,California Contractor's License # 3
is in full force and effect and pro perly/ur o }7 ap
San Jose City Business License # �'
I certify that in the performance of the work for which this permit is issue I shell not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER �/10/79t
ADDRESS DLL� Lot No.
�
USE OF BUILDING m
280-30(9-73) Signed .. !.��. ./G�/. . .......—..��".�,'�..
7562 HOLLANDERRY ACE PLBG.
FIXTURES IN FEE MAIN DRAIN
Nater Heaters l Size Material
Nater Closets To I Fee
Bath Tubs RAIN WATER DRAINAGE
Showers Size Material
Lavatories To Fee
Kitchen Sinks WATER SYSTEM
Dish Washer Size Material
Vaste Disposals Water Fixture Fee
Vash Trays HOUSE GAS PIPING
Vashing Machines No. Lines Outlets
Vater Treat. Equip. Size Fee
Sinks FEES
dental Units Fixture Fees
)rinking Fountains Main Drain Fees
=Ioor Drains Storm Drain Fees
Hoppers Water S s. Fee
Sand Traps Gas Piping Fee
Urinals Surve
Area Drains Permit Fee _
Nater Leaders TOTAL FEE �o
frailer Space INSPECTOR'S REPORT
iwim Pool Gas Piping
ndirect Wastes Approved
)r well B
iackflow Preventer Partial
urvey Approved
B
Rough
TOTAL Approved
/J—G e
Finish
Ap roved
B