58125 r
is
1112 Hollghead Lane
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR GAS PERMIT 7 ,/
---•-"-------- 19.......... Permit No.---• et--S
Date.....-----121-40 f —-----
The undersigned he eby makes a plication to the Plumbing Inspector of the City
of San Jose fora r a I r(c s r gas pipes as listed on the
reverse side hereo , n r s in Isard ap i es and/or pipes in accordance
with the provisions of Ar icle VIII, Chapter 4, of the San Joffe Municipal Code, and
other laws + at in
thereto./�4 �K�If jnVi
I certify that in the perfor t r permit is issued I
shall not employ any person in any manner so as +o violate the workmen's com-
pensation laws of California.
OWNER -.................. t T_ LIrL{P(... -0-1!!Sgg�------------- ------
ADDRESS .........U-/Z....................... 1Q._.........
USE OF BUILDING __R.ESID_EN' '.- E,
.------.... RflWILET-WITiTrANY
• Form 28030 Signed ...............................—.........- -------......-855..ja�hSQa.2lraet...
1112 Hollyhead Lane Crowley Qtbuntain Wew, Ca4af.
11.12 Hollyhe // --- ---- --
CITY OF SAN JOSE, ''rr `, BUILDING DEPARTMENT
f PLICA�ION�/ ,,BUILDING PERMIT
Date_z � ------------------., 19.!x'/. P rm' No.3,7 3-----------
Application is hereby glade for a permit . "-----------'
a------/ / ^toryy 'f. ----'e� ...7rV..l - TT —�_A.... ............. Building
at f.1/...........fir C ------ ---- - ---
to be occupied only as _-- ��
in accordance with Plans, tion ri Imo ewith.
01 Estimated Value of Improvements, /__...__---
It is hereby agreed that the requirements of the San Jose Building and Zoning Ordinances and all other
laws applicable to the construction, location, and use of buildings within the City of San Jose, will be
complied with.
I certify ith. in }he performance of the work for which this permit is issued shall not employ any per-
son in any and ner ss as to late the workman's compensation laws of Cal, r a.
O // �I! 14 �f-- ---F-4 Lh`'J� i/ .LGAet-G
-'----'-----------....Addres .......... .........'---....
tN� .....------.....Address .--. ------......................................'
Cis Or Agent
Form 280-1
r
1,
Type of Appliance No. RemaRe ecc
New Rel
plaacc e Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
(Name Type)
I
TOTAL
FEE
• 'Inspected and Approved By
HOUSE GAS PIPING
Number of Outlets �— I Size of Main
FEE 1hea
Tested and Approved 11- -.-i-4 By a^j
RECORD OF INSPECTION
Found= -- /, . .C/Frame _.1/�.,_:�! .G c ..............
7-2 G/
._e
2
Stucco Sa:_ `' '1_�: :D___' ._ `. �_L- Finish`—/ 23, C 2
s -3=
1112 Hollyhead Lane
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR GAS PERMIT
_5,yl;z.
Date.---------10/✓.01r't.L--------------- 19---'...... Permit No---------'-----------....................
The undersigned hereby makes application to the Plumbing Inspector of the City
re San Jose fora��a6s S s r gas pipes s i listed rd the
reverse side hereo , n. r s m ��s�� ap i es and!or pipes in accordance
with the provisions of Ar icle VIII, Chapter 4, of the San Jose Municipal Code,.and
other laws applicable thereto. / 4. �/�4 ./-
I certify that in the perferetor t r IGLF( s permit is issued I
shall not employ any person in any manner so as to violate the workmen's com-
pensation laws of California. A
OWNER ---.._.........//..... .!..J..!-...�ILIK�.f I. S 4G ........................
ADDRESS --------- ILL---------------------- +..'..O.L LX_4E.r.6.tD.......k&)-------..
USE OF BUILDING ..R-ES IDEN"C"E
Form 280-20 Signed ............... 855-JacM_0R_Street...
1112 Hollyhead Lane Crowley Ubvnfain View, Ggf.
Type of Appliance No. Remarks (Check
New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
(Name Type)
TOTAL
FEE
Inspected and Approved By
HOUSE GAS PIPING
Number of Oufletsl Z I Size of Main 3,1y."
FEE /r00
Tested and Approved 11-L"12.j By