69823 1668 Jamestown
Building Permit Confirmed ❑
Not Required 11.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR. PLUMBING and/or GAS PIPING PERMIT
Cl ;.
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Dalle- -- ✓_ L.-- .(-J.? --------------. 19.Sc'17 Pernni# No.-1(f------ . .
h and ars' ned here makes a 'c �J=�.y lu Ins ecfor of the City of San Jose
for permit } install u p C I' n }he reverse side.
Exemption from re a or a e of a ii role for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ _
Undersigned attests that his }a1 of Cali fnie Confr�LL nse # zz �33y 3
is in full force and effect and pro e I au}hori li I _�
San Jose City Business Licens K
I certify that in the performance of the work for which this permit is issued I shall not emp4.y
any person in any man �r so as to vAafe the workmen's compensation laws of California
OWNER
ADDRESS
USE OF BUILDING � l�
FORM 280-30 IOM 3/67 Signed-7—
igned /'-
.. / ""'-'"'.---.'""""'.• `✓--..���v.'-r'�
1658 Jamestown T&'
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size Material
Water Closets Hoppers To I To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size _ Material
Lavatories A'reo rains - To Curb I To Main Sewer
Ctchen'Sinks Water Leaders - , WATER SYSTEM
Dish Washers Trailer Space Size' I Material
Naste Disposals Swim Pool FEES
Nash Trays Indirect Wastes Fixture Fee
Washing Machines Drywell Main Drain Fee
Water Treat. Equip. ( Backflow Prev enter Storm Drain Fee
;inks Survey Water Sys. ,Fee
)ental Units Gas Piping Fee .'3d
)rinking Fountains Survey
Permit Fee a, O
TOTAL TOTAL FEE •3 O
INSPECTOR'S REPORT HOUSE GAS PIPING
'artial - — No. Lines / Outlets�y—, Size K
lough - Tested and ApprovedGR•5 —'�F
'inish i. BY—D-0-4F, J