21101 7495 'MOLTZEN DRIVE /
Building Permit Confirmed [Y
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING/PERMIT
Date._.------ ---.4'.--------------------.... 197(g. Permit No /
/1 - ------------------
The and ersigne es p ' alio the Plum�b'kng Inspector of the City of San Jose
for a permit }o in II an or i s y�d/on the reverse side.
Esemption fro equir ent or Ste f is rr Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ /7/ a 7
Undersigned attests that his State C sfo{nie Con frac}or's License #'
is in full force and effect and properly s this apleli t-
San Jose City Business License # �/9/
I certify that in the performance of the work for which this permitAs issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER Te6e.1 G-LL-
1QA� ADDRESS 749.E Me�-rZ6AJ Ort.. Lot No. 10
r�+go
USE OF BUILDING
28030(9.73) Signed ..-.ds-�W�r��flnplJl..�.9.-�. :,[{:..........
7495 MOLTZEN DRIVE CENTRAL .SERVICE
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