17723 7716 OROGRANDE PLACE'
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
i `77v...................
Date--------- 0..-� 7......................... 19.7�Permi} No. - - ..
The undersigned hereb ,makes application to the Plumbing Inspector of the City of Sen Jos.
fora permit to install p�m � ref veil pip o sled e ,V Zore4rse side.
Exemption from requuemenbf 5le �qq Califorffnia fonlWantrecterr's License is hereby claimed
by undersigned: As owner ❑ statement filed ❑ _
Undersigned attests that his State of California Contractor's License # U •��'
is in full force and effect and properly euihozi PEce.Horl� /O /�/ _
' Sen Jose City Business License # � ��C `L�.Y{_Y`SS/1//�// j/
I certify that in the performance of the work for which this permitis issued I shall not employ
any person in any manne/rep,es to violate the workmen's compensation laws of California.
OWNER
ADDRESS77 b DJk.fyq� o- e PL • Lot No. /+
USE OF BUILDING a•
LCR CO.,
280-30(9-73) ,r Signed ..----v....----... ............... .
7716 .OROGRANDE GLACE CENTRAL SERVICE
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