211005504 KYNGS�Y7RY PLACE
Building Permit Confirmed LJ'
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
v�
Date ....-------. ..........��4 19.7-(-.. Permit No. --------- --^L----/-----=-......................
The undersigned hereby, m es p is ,}+Wmbjyg I �e ihe,Ci}y of Sen Jose
for a permit to install plumb lIYT,�Y a side.
Exemption from requirement ar S1 a of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ /
Undersigned attests that his State oI Califo i �p, r+')}racier'
is in full force and effect and properly authorize
if..lpplical' n�
Sen Jose City Business License # 4 &— ob 113
I certify that in tha performance of the work for which this permit is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
i2s+c� OWNER I tZE; ALL
S490 ADDRESS 7S0 9' eiN qs 4 Lot No. `E
USE OF BUILDING
280-30 (9-73)
7504 KINGSBURY PLACE
21112
Signed ......r -- �dL . aE2C...--.
CENTRAL,SERVICE
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