12292 805 Lonna Lane
llJ Building Permit Confirmed ❑
INot Required __e _
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPINGS PERMIT
Date-------------------------- /------:. ... 19.7.y. Permit No. -- �7 ------ ----
The undersigned hereby makes application to the Plumbing Inspect of the ity of an Jose
for a permit to install plumbing fixtures and/or pipes listed on the r rse ' e.
Exemption from requirement for State of California for Contract icensi hereby claimed
by undersigned: as owner ❑ ste f fit � 1277C--36
Undersigned aftesfs that h' —St to of Californi Con}r tier's Li n a O
is in full force and effect and prop ly a tho ims t P cat' n. _O(i 6 u
San Jose City Business Li ense /
certify that in the pert rmance of a rk j is permit is issued I shall not employ
any person in any manner so as to viol f rfs c mpensation laws of California. .
OWNER /fLv `
ADDRESS p OS LOl A I'1 Al Lot No.
USE OF BUILDING cs-
280-30 (9-73) SignedC.L.//:-- - �`' 'F... ...x.._`--
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