94968 8062 yark Villa Circle
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Dafe-----/Q_..-1-d..... 1971. Permit No.--...... C...-T.--/.... ..
The undersigned herebyr makes application tithe Plug+bing Inspector of the City of San Jose
for a permit fo install plumbi�g00fix4res�a�d/oropipe��ifed o A ieye`rse side.
s . !6 C o ��y/./.
Exemption from requirement"for Stefe4ofrCalifornia For Contractors License is hereby claimed
by undersigned: (as owner ❑ statement filed ❑
Undersigned attests that his State of CaliforniaeContraefor's License # Sl�
is in full force and effect and properly authorizes this ap`plicetion.
San Jose City Business License # ��� /r / # y
I certify that in the performance of the work for which this permit is issued I shallrnof employ
any person in an anner so es to iolate the workmen's compensation laws of California.
OWNER p�-��
ADDRESS /Ja-?, Lot No.
USE OF BUILDING
Signed .._._DQE-AMA
6Z28030
"?I - ark Villa Circle Amaral
FIXTURES FIXTURES MAIN DRAIN
Wafer Heaters Floor Drains Size !' Moteri
Wafer Closets Hoppers To I To S ' is Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size Material
Lavatories Area Drains To Curb To Main Sewer
Kitchen Sinks Water Leaders WATER SYSTEM
Dish Washers Trailer Space Size '/' I Materia'
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fe
Washing Machines Drywell Main Drain Fee i1
Wafer Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Wafer Sys. Fee
)ental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee .L
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
radial /- /7- )I �M I"I No. Lines Outlets Size
tough i - Tested and A proved -7
i-
'inish _ -7 ,Ger By oN