83391 7561 Newcastle Drive
Building Permit Confirmed ❑
Not Required [c;�
CITY OF SAN JOSE % BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS. PIPING PERMIT
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for a e and to undersigned
herlu bing fEifores en `
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insf
The undersigned here4.". 6� is n o h um Inspector of the City of Sen Jose
d/or ipes listed on the revorso side.
Exemption from requirement for State o0f T'£ for n{�c or'+ L;c is tiereby claimed
-
. by undersigned: as owner (f//
Undersigned attests that his State of Cali orn Con r r s m se
is in full force and effect and properly authorizes {hisepplica{i n.
San Jose City Business License # / 7 —C � U7
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 S`cNAFI DfNC Z2W
ADDRESS -M� I ' C r
USE OF BUILDING �s r
Signed ,:5z. .4.M --
200.30 10-ee
7561 Newcastle Drive Ace lumbitig Sere.
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
LavatoriesArea Drains To Curb To Main Sewer
Kitchen Sinks Water Leaders WATER SYSTEM
Dish Washers Trailer Space Size I Material
Waste Disposals Swim Pool FEES
Wath Trays Indirect Wastes Fixture Fee QG,
Washing Machines Drywell Main Drain Fee
Wafer Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Water Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee ZrO C
TOTAL TOTAL FEE 3:DD
PartialINSPECTOR'S REPORT HOUSE GAS PIPING
Rough No. Lines Outlets Size
Finish —
Tested and Approved
By