112791107 Kentwood
Building Permit Confirmed V--�
Not Required
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date .....-�lJ-------- 19y. Permit No. - -/ L... ?_ 9 -
The undersigned hereby a es a is 'on t rdb' g e for of the City of San Jose
for a permit fo ins}all plu re n s I' i ' reverse side.
Exemption from requirement tate o Calif rnia for Contractor's License is hereby claimed
by undersigned: owner statement filed)v
Undersigned attests that his State o C-nia Co�gj'��a'f��of�i psr(/j/i<y n #
is in full force and effect and properly ut }his e %/ ' v
San Jose City Business License #—F
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 Tnf>1N niD eG�/ll
ADDRESS I�G7 KENIw�dD f}U�� SrT Lo+ No.
USE OF BUILDING 5;/NcrrL£ zcAl) //G-
280-30 (9-73) Signed ------..
110'7 Ketitwood morgan
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