5819 7561 New Castle C'
Building Permit Confirmed ❑
Not Required
CITY OF SAN JOSE BUILDING DEPARTMEN
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date--------
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The undersigned hereby makes a plication fo the Plumbing Inspector of the ify of San Jose
for a permit to install plumbing fixtures and/or pip 6. listed on the reverse side.
Exemption from requirement for Skate of Califf 6� Con} Licenseis hereby claimed
by undersigned: as owner ❑ n it
Undersigned attests that his $feta of California niracior i e
is in full force and effect and properly aythorizes this application.
San Jose City Business License # 60 V
I certify that in the performance of the work for which this permit is issued I shell not employ
any person in any manner so as ioriol/ the workmen's compensation laws of California.
OWNER / �R/�l✓�a�G /
ADDRESS �✓� (n / y��� �`Q' Lot No.
USE OF BUILDING—04-
28030
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