11300 973 November dr
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
j� / ,
Date..................................................-. 19?� O.. Permit No......�.(..---�?�------C------------------
The undersigned hereby ekes a licetion to the Plumbing Ins ctor of the Cit y of San Jose
fora permit to install 1 (' r /dd i�,j��'j�jSf reverse side.
Exemption from rogrq["" C" �7e f s1S pftornrd actor's License is hereby claimed
by undersigned: s owner ❑ statement filed ❑Z / 2 .37
Undersigned attests that his State of CqalfJii�x�3rnintracto 's License #
is in full force and effect and properly au}h'I ;;,&appicp _�,Qt.
San Jose City Business License # /�fII jjTT((Y��6 y
I certify that in the performance of the work for which this permit is issued I all not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER Co c c l wS r
ADDRESS ? 7 3 /VOVEM/3C/L 1D2 Lot No.
USE OF BUILDING 6S
Signed ---- .':.a- F- -- ------ --
28030
9'73 November ace
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