15219 959 November 6t.
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date...............Xcc-- . IL------//------ 10S.-Permit No.-------/Z.�'!../....------- ---------
The undersigned her s�pp{�e�tib��(yPto:fh�l Pfufn bi ;r nn of the City of San Jose
fora permit to install pl 'n�yf(xforbs-�jn a;pi Ra*11Le Qp flro reverse side.
Exemption from roquirement/tor State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed
Undersigned attests that his $tate aliforni. Conto�r}'jc s '?
is in full force end affect and properPM
this p$glit�fjon.
San Jose City Business License # 7� — /c'I,
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 A-i rZ
ADDRESS '51's5 ��vr, 8 ii/u S Lot No.
USE OF BUILDING
280-30(9-73) Sign d ..... `/
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