79580 1133 Kentwood Ave Poo
Building Permit Confirmed ❑--�
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date...... ......5;j�7................ 19.??Permit No.-------- �S- u---------------
Tha undersigned hereby maW.Melo
f he ,t/g�Q/��I/jt,(5�p�4{{for of iha Ci}y of San Jose
fora permit to ins}all plumbinis} V V is Li side.
Exemption from requireme aliform. foContractors License is hereby claimed
by undersigned: �� statement filed ❑
Undersigned d affect
that his pStateroperty
of Califo reef �iyB
is in full force and estec} and properly f Celia s i pa ��/
San Jose City Business License
I certify that in the performance of the work for which this permit is issued I shall ;tot employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER G'f/A PLES O P 7>/!cE �o </zi9
ADDRESS 133 iYErJTGUDLID eJAS SS i3S
U OF BUILDING 5 iUGCE �/d/��/cy i� •
yyy� p .s i.dE,uC,E�`.4e��.J!' ..
SW%r 8ooG H�I/ Signed. ........ .. - 1----- ---------------
.
z0- to-ae 1
1133 Kentwood Ave Bonraa
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 Area Drains To Curb To Main Sewer
Kitchen Sinks Water Leaders WATER SYSTEM
Dish Washers Trailer Space Size Material
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee
Washing Machines Drywell Main Drain Fee
Water Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Water Sys. Fee
Dental Units Gas Piping Fee O
Drinking Fountains Survey
Permit Fee
TOTAL / TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
Portia) No. Line KT Outlets Size --
Rouyh Tested and Approved
Finish B
Y