94679 815 Lily Ave
Building Permit Confirmed ❑
_ Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
10 / 7
Date_.-'.-....----"---..�.U.. ...�.�_._. 197/.... Permit No.---------1.1...CU--/..--- ----------------
-
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plumbing fixtures and/or pipes listed on the reverse side.
Exemption from requirement for State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License #- 3 7 9 0,7C
is in full force and effect and properly authg gs�ti ,aul licafion.
San Jose City Business License # 77// d //
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 C L� /. Ai I"C—/-/An T J7
ADDRESS 87S L-/L y AV9r: ' Lot No.
USE OF BUILDING e p
280 30 /IcSignedl.... -------- ---`��..
875 TAIv Ave (/ Ace Plb2
FIXTURES FIXTURES MAIN DRAIN
Wafer Heaters' Floor Drains Size Material
Water Closets Hoppers To I 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 F Material
Waste Disposals Swim Pool FEES
`Nash Trays - Indirect Wastes Fixture Fee p(/
Washing Machines Drywell Main Drain Fee
Water Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Water Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee 2 ou
TOTAL TOTAL FEE Uv
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines 'Outlets Size
Rough Tested and Approved
Finish