17719 7704 OROGRANDE PLACE
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date.------,0... ----------------- --- 19.7.... Permit No.-----+-171 C�............._.
-i7 S
The undersignedIfle abs makes a plic f on o�ihe�Plum bin .inspec}or of the City of San Jose
for a permit io i�fall pI bRg fi�re and/Jr P" as ' eel onAhe reverse side.
Exemption from nqulre en} for ate .1 01 Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ 7� -
I.
Undersigned attests that his State of CaornieeContrac�or's License #
is in full force and effect and properly aul`ariaoNlhis�a pp �,fia .
San JoseCify Business License #{' f
I certify that in the performance of the work for which this permit is issued I shall not employ
any penin in any mannersy�}z }o
OWNER �/ i late the workmen's comp laws of California.
ADDRESS rI7 0 lI D/L e�y_t rL-�JC �L• Lot No. i7
USE OF BUILDING /qD
280-30(9-73) Signed .._..f✓"' 'u--- _-t--� ---
7704 OROGRANDE PLACE CENTRAL--SERVICE
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