5051 7654 Peach Blossom
V/ Building Permit Confirmed-Ej—"
/ Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date----------------
a-- ------- 19.703 Permit No----------------6.-..��. .g
The undersigned hereby mikes applica}io to he PlumbinP Inspa or of the City of San Jose
for a permit 4o install plumb/fn�J(�fsixr}Lres�an apes`Rif{ d/on the raveerse side.
Exemption from require�ni'f 'SS f of C�r�7a fo-,C.4�ctor's License is hereby claimed
by undersigned: as owner.❑ statement filed a
Undersigned attests that his State of*C-aV A, Contr�C�r's�L isgr e/ ', o —
is in full force and effect and properly �h'o r '+his gpPp Ic�
San Jose City Business License # 7
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 c,�AAla�iNE
ADDRESS /GSSG HEAL N c�LU SSOM • Lot 'No.
USE OF BUILDING
280 30
Signed - ' - - - --
7654 Peach .Blossom Dr. Carolina
c - --I :* aC o 2 MQ atn 0 0 0 � a so e c
m �_ f - 3 �' A p p a v O .�. m _T s N ^ o £ T m m
o - n r D w 1 O N p a
1 f Eto 0 o v N 'o C A 3 ° rt N tort N a- p O x
N O 1
00
D
r < N N a _ p N N N m
p p C A N A
9 N
N
i Z
T
m
m
ma I ma wa ma v nG1 � y 3 T y z � v 1N 1N
'a0 9 '9O A C p O 0 _p H O p H O O
< N N p + m N m ^ M N
'o 0 0o Z 3 ^ 3 c r
a a O m 0 top G ^ S 71 Z
A a ' a
T c y N n 0
N• S D. O a m m T m 1 Y
r am m m -f A G1 T o A m o m A o Z
m mN m DAmNA Aa mO
.� m to C p to _ A ° D
J m m y m D Z