17436 5941 October Way
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
3
Date--- ------ -- �-/-_------ 19�Permr# No.--------[7-04-
Dat
undersigned mafl�efsa apfff�irifion to thooP.lgmbing.Inspector of the City of San Jose
fora permit }o install pl� LJy i/' rate �ip s�l's�d. .pnj l A reverse side.
Exemption from requirement to S'ta'te`6V Ca i rn a�forr Canfractor's License is hereby claimed
by undersigned: as owner ❑ statement filed'
Undersigned attests that his State of California Contractor's License
is in full force and effect and properly ouf♦lgr, -his e io r /��
San Jose City Business License $k AA
I certify that in the performance of foe 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.
r
OWNER
ADDRESS d P Lot No.
USE OF BUILDING n�
280-30(9-73) Signed- r- - - i(�d�/- - -------- ----------- - --_-.
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7941 October Way Ace
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