95521 8101 Park Villa Circle
Building Permit Confirmed Q/
Not Required I]
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Dafe../ ` - -----' ............................ 19-&- Permit No........ 5-- .. --------------
The undersigned hereby jn �applicaon io theme 1ur36yng)lnspecfor of the City of San Jose
for a permit to instalsng>�(,fi tr uie fe,apd�or�Pipesf"e�n the reverse side.
Exemption from regwrome`stt for Sitle of,California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ _
Undersigned attests that his State of Califor ieyGontracfor's�Lic A'so
I, in full force and affect and properly a�orr��f6ii applir`,axsixn''0�
San Jose City Business License (J
1 certify that in the performance of the work for which this permit is issued I shall not employ
any person in any manner so a to violate the workmen's compensation laws of California.
OWNER
ADDRESS U Lot No.;
USE OF BUILDINGARti! PL.0280 30G�,f�s� f
MaIIdc, INC.
�BIQI
Park Villa Circle Amaral Plumbing
FIXTURES FIXTURES MAIN.DRAIN
Wafer Heaters f Floor Drains �Size /' Material
Water Closets .�-- Hoppers To Sep c Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size Material
Lavatories Area Drains To Curb I To Main Sewer
Kitchen Sinks Wafer Leaders WATER SYSTEM
Dish Washers Trailer Space Size /'' Materia
Nasfe Disposals Swim Pool FEES
Nash Trays Indirect Wastes Fixture Fee
Washing Machines Drywell Main Drain Fee
qEj—Z��
Water Treat. Equip. Backflow Preventer Storm Drain Fe
iinks Survey Water Sys. Fee
)ental Units Gas Piping Fee J�
Drinking Fountains Survey
Permit Fee
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
'artial /—/y -7.� No. Lines Outlets Size
Tested and Approved r
IZ-
'inish ° By OMA Al(Z
W19-7-6,-IF 3-�6 �� 9�P9asrr