95523 8115 Park Villa Circle
Building Permit Confirmed LZ]_�
Not Required ' ' ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Dafe---�u'VL`---+-------------------------- 19_7/ Pernnif No.,.---- -------- -
Tho undersigned h r �sYa�$i/a�1i a onJto 40 lu�s}�in I pactor of the City of San Jose '
for a permit to insfall�l�ipsbjngfiikfuri`d�o�pipe�s��iife� e reverse side.
Exemption from requireme for State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed '
Undersigned attests that his State rl of Califor is�rC..-ontract ,Llpe�#�
is in full force and effect and properly authori:�alR�jeppli,ef
San Joie City Business License # LOQ!�2Z - -
I certify that in-the performance of the.work for which this permit. is issued I shall not employ
any person in an manner so as to violate the workmen's compensation laws of California.
OWNER p
ADDRESS Lot No.
USE OF BUILDING'
AMAR PLUMBING, INC'
]00.30.. .4 / Signed
tla.14W f''k Villa Circle Amaral Plumbing
FIXTURES FIXTURES MAIN DRAIN
Water Heaters / Floor Drains Size a Mater'
Water Closets Hoppers ' To 5 tic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size ' I Material
Lavatories ,'{� Area Drains To Curb I To Main Sewer
Kitchen Sinks. Water Leaders WATER SYSTEM
Dish WashersG Trailer Space Size /'� Mater'
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes- Fixture Fee .
Washing Machines Drywell Main Drain Fee Z.
Water Treat. Equip. Backflow Preventer Storm Drain Fee -
(Sinks Survey Water Sys. Fee /. /75
'Dental Units Gas Piping Fee -57
Drinking Fountains Survey
Permit Fee Z.
TOTAL' TOTAL FEE /
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial — 1R �/ No. Lines Outlets Z Size
Tested and Approved
Finish `- By ./..n