26614 Fill KENTWOOD AVENUE Building Permit Confirmed ❑
�j Not Required ❑
CITY OF SAN JOSE / BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date....- ...........
/... ../ .�...... ..... 1�7 Permit No......r�.6)0T
The undersigned her by mak a pl' tion�p.t a P �g Inspector of the City of San Jose
{ora permit fo install f' r n �j6rJpj�4�jiS1 on the reverse side.
Exemption from I e a a of Grjfifo'rrnia oor Contractor's License is hereby claimed
ley undersigned: as owner ❑ statement filed ❑ 7
Undersigned attests that his State rota o fr r' n e
is in full force and effect and properI t'
Sen 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 fo to the workmen's compensation laws of California.
OWNER
ADDRESS 1111P�17Gf/�D� /!r Lot No.
USE OF BUILDING
Signed ..... `1 �7
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