21100 7492 .KYNGSWRY. PLACE
Building For Confirmed 171��
Not Required ❑ '
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Drife..........--- --- --------------------------- 1971.4a. Permit No............
....
......----.......
The undersigned hereby kes applicatio 1 he,�+sg4in Ins r of the City of San Jose
for a permit to insf.11 plu m i s p rs ¢ r arse side.
Exemption from require a fate Ca i ornia or on ac or's License is hereby claimed
by undersigned: a owner ❑ statement filed ❑1 -71)
„' I j 3, 7
Undersigned attests that his State ofCalifornia Contractor's License #'
is in full force and effect and properlye' ori;q xis a P,, ti .
San Jose City Business License # ff t-
I certify that in theperformance of the work for which this permit is issued I shall not-employ
any person in any me nnor so as to violafe the workmen's compensation laws of California.
OWNER 'rte tr N G L�
S4 f oADDRESS 7 4 9 L ICi n/ 9 S � Lt �L Lot No. (a
USE OF BUILDING i2e ( —
280-30 (9-73) Signed...... -en-'JIM------
7492 KINGSBURY PLACE CENTRAL SERVICE
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