12373 1118 Hollyhead In
Building Permit Confirmed ❑
(� Not Required .—G--
CITY OF SAN JOSE - 1 BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING
�/ PERMIT
Date-...-----------'-----/�-- '/- -- -- 19.7-Y. Permit No.----------------�.<�-(..�_.....
The undersigned hereby m s appli io to he Plumbing Inspector of the City of San Jose
for a permit To ins}all plre a (reverse side.
Exemption from require a ni n ctor's License is hereby claimed
by undersigned: a owner s4atement filed OZ�� Z S•� C, 3,�
" Undersigned attests that his State of Caliicrnia�C.Qpb, toJJJ' License '
is in full force and effect and properly au#horjz��jy�yplicw//A
San Jose City Business License # F/ ��
I certify that in the performance of the work for which this permit is issuPtl I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER XA1)t?. ,St-K, F
ADDRESS ///e NOcL-Y 11 =A1) LN Lot No.
USE OF BUILDING n(--T
280-30(9-73) J Signed,I c - )_/� .,2o.^-sK�C.:t'. l//-� ".i
lllR TTnllvhaad IJ// ace��l`--
FIXTURES NO. FEE MAIN DRAIN
Nater Heaters ,00 Size Material
Nater Closets To I Fee
Bath Tubs RAIN WATER DRAINAGE
Showers Size Material
Lavatories To lFee
Kitchen Sinks WATER SYSTEM
Di5h W s er Size Material
Noste Disposals lWater Fixture Fee
flash Trays HOUSE GASP IPING
Vashing Machines No. Lines Outlets
Vater Treat. Equip. Size IFee
Sinks FEES
Dental Units Fixture Fees rpp
Drinking Fountains Main Drain Fees
Floor Drains Storm Drain Fees
HoppersWater 5 s. Fee
Sand Traps Gas Piping Fee
Urinals I Survey
Area Drains Permit Fee 2,c0
Nater Leaders TOTAL FEE , .00
Trailer Space INSPECTOR'S REPORT
Swim Pool Gas Piping
ndirect Wastes Approved
)r well B
3ackflow Preventer Partial
urvey Approved
B
Rough
TOTAL /,00 Approved
B
Finish
Approve 1 — Z
B e�