4269 1575 Jamestown Drive
Building Permit Confirmed
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS
JPIPING
CPERMIT
Dafe---,Z/ -------- - - PI
19........ Permif No.--
---.:-1.: ..(`.'.-------------------
The undersigned here a es I'c n tP Iu Inspec{or of the City of San;Jose
for a permit to install n o / p I' on +he reverse side.
Exemption from raquireme for fe of Ca ifornia for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ _
Undersigned attests }hat his SfaAdV.li(orniry/�cy''
is in full force and effect and prorfy Niorixes AhK P c
}/aloll/ 4
San Jose City Business License #
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.
OWNERr�,yK
ADDRESS Z-: 71' �`LOf No.
USE OF BUILDING
280-30Signed _. _ � _. _ ---- ?7..................
1I ;?; Jamestown Drive ` �/
FIXTURES NO. FEEI MAIN DRAIN
Noter Heaters I Size ` Material
Nater Closets To Fee
Bath Tubs RAIN WATER DRAINAGE
Showers Size Material
Lavatories To IFee
Kitchen Sinks WATER SYSTEM
Dish Washer Size Material
Naste Disposals Water Fixture Fee
flash Trays HOUSE GAS PIPING
Vashing Machines No. Lines c'. j Outlets /
Yater Treat. Equip. / Size Fee
Sinks FEES
Dental Units Fixture Fees /q,
Drinking Fountains Main Drain Fees
Floor Drains Storm Drain Fees
Hoppers Water Sys. Fee
Sand Traps Gas Piping Fee :;j 0
Urinals Survey
Area Drains Permit Fee oma. 0-0
Nater Leaders TOTAL FEE • b
Trailer Space INSPECTOR'S REPORT
iwim Pool / GasPi in
ndirect Wastes Approved ,"— 7-3
)r well By 04,741ki�
Backflow Preventer / Partial
urvey Approved — ] 3
Rough
TOTAL Approved
B
Finish
Ap roved –71—
B