27500 1140 KENTWOOD
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION/ /FOR PLUMBING and/or GAS PIPING
j PERMIT
Date...... --(..(f/._................ 14/. Permit/ No........�-f...`� -O...........--......
The undersigned hereby ekrEio
5 ubd.a )MpDc+or of the City
of Sen Jose
for a permit to install plumo li reverse side.
Exemption from requirement California for Contractor's License is herebyclafimed
by undersigned: clstatement aimed
by /
Undersigned attests that his Sfeto of f rtR Con r i #
is in full force and effect and properly au iia p �/
San Jose City Business License #
I certify that in the performance of the work fortwhich this permit is issued I shall not employ
any person in any m nner so as 5 violate the workmen's compensation laws of California.
OWNER
ADDRESS d Lot No.
USE OF BUILDING
280-30 (9-73) S9n
ed ----
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AC1140 KENTWOOD
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