12509 1012 November drive
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date-------------------.//.. .3-- .....-. 19.7./. Permit .No.------ - -5 --. ..--------------
The undersigned hereb�rr��aakg/��ap�p}r'r��afi n to f�re Pl�mbi g,pspe �'Cf the City of San Jose
for a permit to install pl�rgb4 f`I�Rai �listed�o th rax vel side.
Exemption from requirement I State of California for Con rectors License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ ��'�23'7 CJ'C
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly a.thjeS is applfCet'on.
San Jose City Business License
I certify that in the performance of the work for which thispermi_t is iss d_I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER J-C4 k 5--r N /-)
ADDRESS /O/ Z Lot No.
USE OF BUILDING
280-30(9-73) - Signed-a1c L-.P. ..jam..9'f'.v.--`.'.`-/P "-`- --.
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