17728 7724 OBSIDIAN CT. /^w
I 'Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS/PIPING
22 PERMIT
Date....--- 6'-1 ----------.....------.... 19.7L-.. Permit No-------F---17,29------------
The unclersignecl hfr49,y pskjs application to the Plumbing Inspycfor of the City of Sen Jose
{ora permit to install plurtrbinFt�-f }u9i�� pi� Mist ed s�p(6A'�r&erzo side.
Or
Exemption from requirreYmeenff'for/vsfattee AClalifornia too, Coontrraccttor's License is hereby claimed
by undersigned: *as owner Elstatement filed E] /7!r�,7
Undersigned attests that his State ofaCalifornia Contractor's License #—
is in full force and effect and properly%arh'es thiss epplicaf'og!
San Jose City Business License #- Qqt�(� r6
I certify that in the performance of the work for which this permit is sued I shall not employ
any parson in any manne,r �} es fo riolafe the workmen's compensation laws of California.
OWNER
ADDRESS 1-72-4 4 Lot No. Z—
I '
USE OF BUILDING
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280.30(9-73) � Signed -------"-------....----' --.. ...............
7724. OBSIDIAN CT. CENTRAL SERVICE
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