98035 7573 I-Iollanderry P1.
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
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2
Date_..-------------v-------.'.3....�. .....-... 19.E 2.. Permit No.------�. �L-3--------------`
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install m in fi tures and/or pipes ' ted on the verse side.
Exemption from equi o ali{or fry o tors License is hereby claimed
by undersigned: as o � fb'mont filed �Z7 c/OS'
Undersigned attests that is State of California Contractor's License #
is in full force and effect and properly a orizes this application.
San Jose City Business License # 16 U
I certify that in the performance of err for`rf r d� �tj miss. shall not employ
any parson in any manner so as to viola a the workme s compansatiorMews of California.
OWNER S6LtTO. •J: /Z.
ADDRESS 757.3 fl0«/"V 'Zy �t Lot No.
USE OF BUILDING q
280 30 Signed
U ------------------
7573 Hollanderry P1. Ace Plbg.
FIXTURES FIXTURES MAIN DRAIN
Water 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 MachinesDrywell Main Drain Fee
Wafer Treat. Equip. Backflow Prev enfer Storm Drain Fee
Sinks jSurvey Water Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee <.o0
TOTAL TOTAL FEE &- Go
INSPECTOR'S REPORT HOUSE GAS PIPING
'Ort1OI No. lines Outlets Size
tough Tested and Approved
•mish By