22107 1135 HOLLYHEAD LANE -
pep��f exaT«v
Building Permit Confirmed c /f
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date....q-..... '-2)-------------------..........-- 197.j7. Permit No......... /-----2-----------
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install f' p� K e everse side.
Exemption from r gyi�r�a� y�o o cfor's License is hereby claimed
by undersigned: as owner ❑ statement filed S33
Undersigned attests that his Statex of orn onpla Ir's is
is in full force and effect and properly eu or ji-a J/tyyfi
San Jose City Business License # — ! !7/
I certify that in the performance of the work for which this permit is issued I shall not employ
.any person in any manner so as to violate the workmen's compensation laws of California.
OWNER 11,.V AVCC� /
ADDRESS yr �� /7�////p �+ �^ Lot No.
USE OF BUILDING
280-30(9-73) Signed �:'- ------_------------
11-39 HOLLYHEAT) LANF ��� 14/T,ITMBINrT
FIXTURES NO. FEE MAIN DRAIN
Water Heaters Size Material jf
Water Closets 2 To Fee
Bath Tubs / RAN WATER DRAINAGE
Showers Size Material '
Lavatories 4 To IFee
Kitchen Sinks WATER SYSTEM
Dish Washer Size Material Cw
Naste Disposals Water Fixture Fee
Vash Trays HOUSE GAS PIPING
Vashing Machines Na. Lines Outlets
Vater Treat. Equip. Size Fee
Sinks FEES
)ental Units Fixture Fees fr 0(-,-
)rinking Fountains Main Drain Fees
'loor Drains Storm Drain Fees
Hoppers Water Sys. Fee z 00'
Sand Traps Gas Piping Fee
Urinals Survey
Area Drains Permit Fee m
Nater Leaders I TOTAL FEE 00
trailer Space INSPECTOR'S REPORT
iwim PoolGa in "
.direct Wastes Approved
)r well B
lackflow Preventer partial
urvey Approved
by Z&,A,0 ...:
Rough
TOTAL Approved LD
Finish
Approved
B