17729 (2) 7 2'O sbsb idianU �LtC �C,
Building Permit Confirmed fT —
.-��� Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR.PLUMBING and/or GAS PIPING PERMIT
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Date-- ---�---�/ . . . ....----— 19..---... Permit No.....i.. .�. ...
The undersigned herQF�mdfc,>•ppp�celien f�se P min �yefof the City of San Jose
for a permit to install 61bi�g�yl((rfffu r fNplpes hsi on hoareverse side.
Exemption from requirement or State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of Cali ip Pontrec}or Li # �..� 3 7
is in full im a and effect and properly eu}ho i ai Y�is � Ifte�
San Jose City Business License # �A' -
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in eny ma ar so as to •,,.tate the work en's compensation laws of California.
OWNER � 7��� dd ���
ADDRESS 7L ,2 F 44&,Sl ltl"' Lof'No.
USE OF BUILDING
280-30 (943) . Signed.....-----------...--------....-------------------------.`-:.---
i
7728 Obsidian
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