12066 1154 Kentwood Ave.
Building Permit Confirmed ❑
Not Required •'�]�
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION/ FOR PLUMBING and/or GAS PIPING PERMIT -
Date------------------- �. --- -- ----- 197y. Permit No........ / ---------------
The undersigned her makes pl' ati to th lumbin nspector of the Cify of San Jose
for a permit to install u r a d e reverse side.
Exemption from r or o ma racfor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑z�� ,� 3 -� C.f�
rUndersigned attests that his State of California Contractor's License #
is in full forceend effed anope authorize his p li at'�TV —O/
San Jose Cify Business Li c e (—
I certify that in the performan of the work for which this p rmif is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER
ADDRESS 1�i�7/ ��ti'TGcrooD � V Lot No.
USE OF,BUILDING L
. . 280-30(9-73) Signed .e :zt'...���.�=.`."-:��-P.. ---/��.....
1154 Kentwood Ave. Ace
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