81018 7562 HolLanderry Place
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR/PLUMBING and/or GAS PIPING, PERMIT
Date..........✓.----/-�- ------y-. 19........ Permit No.---------4 ✓ .If.........
The undersigned here maJre; a at'p 1�c �! q orof the City of San Josa
for a ermi} }o msfal I mb'�g(�.(�y res Q lr erre side.
Exemption from rages ment fate C rniaor's Licenze is hereby cleimed
by undersigned: s owner ❑ ent filed ❑
Undersigned attests that his State Ca ifornia Contractor's License
is in full force and effect and prop a aa ihi p�ryef+ ��
San Jose City Business License ,y
I certify that in the performance of the work for which this permit"s issued I shall not employ
any person in any manner so as }violate the workmen's compensation laws of California.
OWNER_r � 7`
ADDRESS [p —/kol //_G__!_1C
USE OF BUILDING
FORM 280-30 10M I/68
Signed _... ---/..C.'- U------- ------!"1-C)1.��Lf1.J
7562 HolLanderry Place Victor Thomas
oClosetsHoppers
IXTURES FIXTURES MAIN DRAIN
eaters Floor Drains Size Material
osets Hoppers To To Septic Tank
s Sand Traps RAIN WATER DRAINAGE
Urinals Size Material
s Area Drains To Curb To Main Sewer
inks Water Leaders WATER SYSTEM
shers Trailer Space Size Material
isposals 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 as Piping Fee
Drinking Fountains Survey
Permit Fee
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
lough
No. Lines
louOutlets Size
tough Tested and Approved
finish By