99452 820 Kim /
Building Permit Confirmed ❑
C Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date-------------------- -�..� -`- ---------- 197--.L Permit No...---- --!' -. ------------
The undersigned hereb es epplicaf;o 4o e P i Ins or of the City of San Jose
for a permit I insfell p mbi e s e verse lido.
Exemption from roqu"arse
ata alifo is or Contractor's License is hereby claimed
by undersigned:. s owner statement {led ❑
Undersigned attests that his State o aliforn C tractor's License $k
is in full force and effect and properly a thorixa i pplice '
San 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 t violate the workmen's compensation laws of California.
OWNER2 LC�'F✓iL«'
ADDRESS/ ! /� Lot No.
USE & BUILDING y
280 30 Signed- ---'-.. - -----"-- - - -- -- ----`-"- `
820 Kim Bellefville
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size Material
Water Closets Hoppers To To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size
-Material-
Lavatories Area Drains To Curb I 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
Drinking Fountains Survey
Permit Fee e
TOTAL TOTAL FEE
INSPECTOR'S REPORT
Partial HOUSE GAS PIPING
No. Lines Outlets Size
Rough Tested and Approved
Finish —J 7 Lam- ��^M By