21100 - 5538 '-KYNGS�URY PY�P.C1✓ /
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date----------c�_`�. .76------------------ 197,... Permit No..........7/-'-f-0-11-------------------
The undersigned hereb pike, a li fioi o the Plymbing In actor of the City of San Jose
for a permit to ins}ell p as reverse side.
Exemption from re amen} or SW of al o�for on Factor's License is hereby claimed
by undersigned: as ownerstatement filed C] -37
Undersigned attests that his State of C i r ontre me� 7/1
is in full force and effect and properly auf x sap i
San Jose City Business License f f
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 to violate the workmen's compensation laws of California.
OWNER i 2 GN E LL
TIZAr-f ADDRESS 7S 38 e,Ai Q LlU2N �L Lot No. -7..f✓So /f
USE OF BUILDING Ak
280-30(9-73) Signed----- -d?(LISI. Q.vo.,-. im-----
7538 KINGSBURY PLACE CENTRAL .SERVICE
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