160761092 November dr
Building Permit Confirmed []/
Not Required d
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING la d/or GAS /PIPING// PERMIT
Date--------------- .- ... 19.7j9Permit No lk-7.-------------"
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plumbing fixtures and/or pipes listed on the reverse side.
Exemption from requirement for State 21 California for Contractor's License is hereby claimed
by undersigned: as owner KI statement filed E3
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorizes this application.
San Jose City Business License #
I certify that in the performance of thiel 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 a(—E
ADDRESS Lot No.
USE OF BUILDING
280-30 (9-73) Signed ------ �1�.....-Al..-----` -------
1092 November McComb
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