12820 1614 Jamestown Dr. ^
/./ Building Permit Confirmed ❑�
Not Required - I
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING? PERMIT
Date-------------------------/ o--- -------- 19'2'r- Permit NN�o--------------- Z za-----
Tho undersigned here' k p t a ' t u/rymnq Inspector of the City of San Jose
for a permit to install pl pro y VliLtbd.6n the reverse side.
Exemption from requiremen or State of California for Contractor's License is hereby claimed
by undersigned: as o r Jar%�e ! filed ❑10 / ,X37 C.3b
Undersigned attests that his St a ali n c r ase #
is in full force and effect and prop ry a hoaxes this applicatio V
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.
OWNER V11"127 E-, /1 .
ADDRESS l G <T/t/�6S TOk't/ Lot No.
USE OF BUILDING 2�
280-30(9-13) Signed -.----
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1614 Jamestown Dr. Ace
FIXTURES N0. FEE MAIN DRAIN
Water Heaters Size Material
Water Closets To Fee
Bath Tubs RAIN WATER DRAINAGE
Showers Size IMaterial
Lavatories To IFee
Kitchen Sinks WATER SYSTEM
Di5b Washer /,00Size Material
Waste Disposals Water Fixture Fee
Wash Trays HOUSE GAS PIPING
Washing Machines No. Lines Outlets
Water Treat. Equip. Size TFee
Sinks FEES
Dental Units Fixture Fees Z,00
Drinking Fountains Main Drain Fees
Floor Drains Storm Drain Fees
Hoppers Water Sys. Fee
Sand Traps Gas Piping Fee
Urinals Survey
Area Drains Permit Fee x.00
Water Leaders TOTAL FEE 3.0o
Trailer Space INSPECTOR'S REPORT
Swim Pool Gas Piping
Indirect WastesApproved
Dr well B
Backflow Preventer Partial
>urvey Approved
B
Rough
TOTAL /•00 Approved
B
Finish
Ap roved 3 7
B