79572 856 Kim.
Building Permit Confirmed ❑
Not Required
CITY, QF SAN .JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
-�7Z
Date- �% .'i.. r.........—..... 19ai/`-.. Permit No.""-- -.........-----
Thpermit to ind herebyapplication to t Plumbing Inspector of the City of Sen Jose
for a permit }o,insla p u b' g iv} !r� �r pi lirt o4fnC!-isiy(7ererxe side.
- Exemption from re (o t of b o is actor's License is hereby claimed
by undersigned: as owner ❑ _ statement filed ❑
Undersigned attests that,his,state'of California Contractor's License # aS J9`'� 52,
is in full force and effect and properly a onzes is applicaf' n. /�
`/)sr, ,
San Jose City Business-License # " —i U� ;6 — -
I certify that in the perfoimance Xf a work—for which this permit is issued I shell not employ
any person in any manner,so_as.fd'violate the workmen's compensation laws of California.
OWNER
ADDRESS
USE OFiBUILDING,,;,•.r
Signed ----------
_.. 856 Kim Ace
FIXTURES FIXTURES MAIN DRAIN
Wafer Heatprs 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 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 DrywallIRe
ain Fee ,
Wafer Treat. Equip. Backflow Pre enterrain Fee
Sinks Surveys. Fee
Dental Units ng FeeDrinking Fountains e �TOTALOTALFEE �, epINSPECTOR'S REPORT HOUSE GAS PIPINGPallial Outlets Size '
Rough Tested and Approved
Finish i/0, ,..� 1 By