68366 1590 James*Own /0 Building Permit Confirmed ❑
Not Required Q�
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date.............................. ...- i7� 19.17-7 Permit No......
f�/-.The undersigned her y makes application to the Plumb" Inspector of the City of San Jose
_ for a permit to install - /o list the reverse side.
Exemption from re or all o ontractor's License is hereby claimed
by undersigned: as owner ❑ statement filed El_
Undersigned attests that his S ofyyC,, alifornia Contractor's License #�' `6 - —�
is in full force and affect and pro rlorize p liOf
i/../
San Jose City Business License
1 certify that in the performance ef'fhe work for which this p rmit is issued I shall not employ
any person in any manner 4o as to violate the workmen's compensation laws of California.
OWNER
ADDRESS 107 Q nCLNv� Q 1 P��L�Vl Jl
USE OF BUILDING
� �qq
FORM 280-30 IneV. 3/661 IOM Signed : ...... -' - - - -
1590 Jamestown Serv-all.
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size Material
Wafer Closets Hoppers To I To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size Material'
Area Drains To Curb To Main Sewer
Lavatories WATER SYSTEM
Kitchen Sinks Wafer Leaders
Size Material
Trailer Space
Dish Washers FEES '
Waste Disposals Swim Pool
Woo
ash Trays Indirect Wastes Fixture Fee r
Washing Machines Drywall Main Drain Fee
Water Treat. Equip. Backflow Pre enter Storm Drain Fee
Sinks Survey Water Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains Survey - - • '
Permit Fee -00
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines Outlets Size
Rough Tested and Approved
`-� Finish By