19791 7775' LILAC WAY
Building Permit Confirmed ❑
Not Required .e—
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FORM HANICA/L(�PPERMIT
Date...............`(. _ �............--- 19.. r. Permit No....._7 G-77/ /---....---......-
The undersigned hereby makes application to the Plumbing Ins e,for of the City of San Jose
'fore permit to install th me a r i
Exemption from req m K a rn or C actor's License ereby claimed
by undersigned: owner ❑ statement filed
Undersigned attests that his State of or Contr L' s Yom( L
is in full force and effect and properly a rthis pfl i
San Jose City Business License # OO 2-
1 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
ADDRESS �77�_� L G+L 7 Lot No.
USE OF BUILDING
Signed.. ... .......... --.._...------..- --.. ... . ..
7775 LILAC WYA
A & H HTG. 280-404n
v
u
m m
w
K LL LL N LL LL O N
E MAl9 U i K
W `
d (�
O h
O
m m m �n U LL 2 U O � ll LL Q Z m