95928 8075 Park Villa Circle
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date_.USX '-.:--- .------------------ 19-,V.. Permit No..............4Z Y— .-------
The undersigned h�b4/�hmkes Wig-f-7b--�lu�b�n�spec#or of the City of San Jose
for a permit to ins#allPllu bingr"fi.ftwe and:Or pipes lisfedeon the reverse side.
Exemption from requirement for State of California for Contractors License is hereby claimed
by undersigned: as owner ❑ r statement filed ❑ f,
Undersigned attests that his State of California ContractoA7,Licans
is in full force and effect and properly authorisrsthis applicpfiogf�V �d
San Jose City Business License #—���
I certify that in the performance of the 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.
OWNER � /� 'Js �/�
ADDRESS p2:f4& Z �' iLo+ No.
USE OF BUILDING
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2e0.30 Signed..-- -----------------------------------
Ccs. ...
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Pnvlr v; r i m r-; r,-i 0 Amaral
FIXTURES FIXTURES MAIN DRAIN
Wafer Heaters Floor Drains Size Materi
Water Closets ',L Hoppers To _ To S tic Tank
Bath Tubs / Sand Traps RAIN WATER DRAINAGE
Showers / Urinals Size Material
Lavatories Area Drains To Curb To Main Sewer
Kitchen Sinks , Wafer Leaders WATER SYSTEM
Dish Washers Trailer Space Size .r Materia
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee - 9
Washing Machines I Drywell Main Drain Fee
Wafer Treat. EquiP.T Backflow Preventer Storm Drain Fee
iinks Survey Water Sys. Fee Z. /�
)ental Units Gas Piping Fee sfJ
Drinking Fountains Survey
Permit Fee
TOTAL TOTAL FEE /—`
INSPECTOR'S REPORT HOUSE GAS PIPING
�O„1OI .F "7-7 2 A-F1Tsn/ No. Lines Outlets Size
lough L ,q/,Gri;1 dW772 l-j;, Tested and Approved 72
'inish — L a By �iA`