79603 881 Lily AP
Building Permit Confirmed ❑
Not Required Lr
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date... ... ...7.. .`�................. MO. Permit No.------��.-. -..............
T undersigned hereby makes application fo 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 _ _ �y
Undersigned attests that his State of.California Contractor's License # q ��
is in full force and effect and properly eu}horrz }his a�fl�tioy��//
San Jose City Business License # �
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 vi late the workmen's compensation laws of California.
OWNER O
ADDRESS42
`P
USE OF BUILDING �2 //J
280.30 10-99
Signed .-Gr/ — ---------------
�zc
881 Illy Ave AA
FIXTURES FIXTURES MAIN DRAIN
Wafer Heaters � Floor Drains Size Material
Wafer Closets Hoppers To To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size Material
Lavatories Area Drains To Curb I To Main Sewer
Kitchen Sinks Water Leaders WATER SYSTEM
Dish Washers Trailer Space Size Material
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee O d
Washing Machines Drywall Main Drain Fee
Water Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey. Wafer Sys. Fee
Dental Unifs Gas Piping Fee -
Drinking Fountains Survey
Permit Fee �p ,d O
TOTAL TOTAL FEE p
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines Outlets Size
Rough Tested and Approved
Finish �� By