31617 1034 PENNINGTON WAY
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APfLICATION ,FOR PLUMBING and/or GAS PIPING PERMIT
Date - .. ------------- 19�Permit No.. ......3-x..6--`�--.............
The undersigned hereby makes.applicaiion�to fhe3Plo�n bing,lnspector of the City of San Jose
Fore permit to install plumipg'
bfiiiur�/[end.or pipes listed o i erverse side.
Exemption from requirement for Sfafa of California for on}rector's License is hereby claimed
by undersigned: as owner ❑ statement filed
Undersigned attests that his State of Caliidrnie Contractor's License #
is in full force and effect and properly aut r 1 th(s=epplic
San Jose City Business License # 44424
I certify that in the performance of the work for which this permit is issued'Irshall not employ
any person in a so as to violate the workmen's compensation laws of California.
OWNER
ADDRESS
USE OF BUILDING
Signed .__ ...... ..........
28o<401n
1034 PENNINGTON WAY PACE PLMB
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