76590 7561 New Castle
/'. Building Permit Confirmed ❑
V` Not Required L2]'
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLIC TION FOR PLUMBING and/or GAS PIPING PERMIT
Date....----�-- -`'-'•-�-J-'/JIJ-)' - /0----------- 19...5. Permit No.---------------/--—--`--- --------
The and igneH hereby ekes a plica}ion to +he lumbi Inspector of the City of San Jose
for a permit to install plu i ur r p f the reverse side.
Exemption from requir of a�f r a o onfr.cfor's License is hereby claimed
by undersigned: s owner ❑ statement Filed F v
Undersigned attests that his State of California o
is in full force and effect and properly aufhorixes i icaf �
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 violate the workmen's compensation laws of California.
OWNER U.4 (JI > S�ffp�v-01 YC
ADDRESS /SG! b✓C
USE OF BUILDING--Jef`S T AND M HEATING
/I AND
FORM 280-30 10M 1/68 Signed--- -- --------------- AIR'�OJ!b1T1DNING
7483 DE LA FARCE DRIVE
7561 New Castle T&MSAN JOSE, CALIF. 95129
FIXTURES FIXTURES - MAIN DRAIN
Water Heaters Floor Drains Size Material
Water Closets Hoppers To 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 FMat.rial
Waste Disposals Swim Pool FEES
Wash Trays, Indirect Wastes. Fixture Fee
Washing Machines Drywell I
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
TOTAL TOTAL FEE --
INSPECTOR'S REPORT HOUSE GAS PIPING
PaAial �
Rough No. Lines Outlets Size
Tested and Approved
Finish
By