29429 1140 HOLLYHEAD LN.
Building Permit Confirmed ❑
/� Not Required I_�
CITY OF SAN JOSE I BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
9 '
Date........... -. ...�----------- -
--- -- 19........ Permit No..... .. - ..................
The undersigned here mPs
p' a#i to the Plum Ging ctor of }ha Ci of Sen Jose
For a permit fo install u i a r p es if reverse side.
Exemption from re e of or o rec}ox's License is hereby claimed
by undersigned: ner ❑ statement {fled ❑
Ziii-
Undersigned a#}esfs "af his Plate``ppjj C11FFF....sFornie C #r }o ' Li
is in full force end off oct and properu}jFp[has fhi c
Sen Jose City Business License 7 S
I certify that in the performance of the work for which this permi# is issued I shall not employ
any person in any manner so as to vi la#� workmen's compensation laws of California.
OWNER
ADDRESS Z> _ Lot No.
USE OF BUILDING
gned
280-401n
1140 HOLLYHEAD LN. ���� '-ACE
FIXTURES NO. FEE MAIN DRAIN
Water Heaters Size Material
Water Closets To Fee
Bath Tubs RAIN WATER DRAINAGE
Showers Size Material
Lavatories To IFee
Kitchen Sinks WATER SYSTEM
Di5h Washer SizeMaterial
Waste Disposals Water Fixture Fee
Wash Trays HOUSE GAS PIPING
Washing'Machines No. Lines Outlets
Water Treat. Equip. Size IFee
Sinks FEES
Dental Units Fixture Fees d1/
Drinking Fountains Main Drain Fees
Floor Drains Storm Drain Fees
HoppersWater S s. Fee
Sand Traps. Gas Piping Fee
Urinals Survey
Area Drains Permit Fee
Water Leaders TOTAL FEE
Trailer Space 'INSPECTOR'S REPORT
Swim Pool Gas Piping
Indirect Wastes Approved
Dr well B
Backflow Preventer Partial
Survey Approved '
By
Rough
TOTAL Approved
B
Finish
Approved - i�
B y