762211497 Plum Blossom
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS 1 G PERMIT
Date- .. - .. a..�/ ......... 19- 1�$"Permi#,No...... ---------------
The undersigned hereb makes I' }ion u��b{i/ng Inspector of the City of San Jose
for a permit to install in }u e'! ukg reverse side.
Exemption from requi'"r8 $r N a1 f �lifornie for Cbnfrector's License is hereby claimed
by undersigned: az owner ❑ statement filed ❑
Undersigned attests that his State of Califq is on+rac}or <e e
is in full force and effect and.properly au+horizW t.applicatiln
San Jose City Business License # "X— /o? % 2 y
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 as to violate the workmen's compensation laws of California.
OWNER
ADDRES!
USE OF BUILDING
FORM 280-30 10M 1/68
1497 Plum Blossom.
Signed Lid,/,.�cJ--_
Ace
nUwt lsA] PIPING
Partial No. Lines
Outlets Size
Rough ��� ^ nf/ Tested and Approved
FinishtI �O'--c/ —f/ v.,v v- �- By
FIXTURES
FIXTURES
MAIN DRAIN
Wafer Heaters
Floor Drains
Size Material
Water Closets
Hoppers
To I To Septic Tank
Bath Tubs
Sand Traps
RAIN WATER DRAINAGE
Showers
Urinals
Size
Material
Lavafories
Area Drains
To Curb
To Main Sewer
Kitchen Sinks
Water Leaders
WATER SYSTEM
Dish Washers
Trailer Space
Size Material
Waste Disposals
Swim Pool
FEES
Wash Trays
Washing Machines
Wafer Treat. Equip.
Indirect Wastes
Drywell
Backflow Prevenfer
Fixture Fee
Main Drain Fee
Storm Drain Fee
Sinks
Survey
Water Sys. Fee
Dental Units-
Drinking Fountains
Gas Piping Fee
Survey
Permit Fee
TOTAL
TOTAL FEE
nUwt lsA] PIPING
Partial No. Lines
Outlets Size
Rough ��� ^ nf/ Tested and Approved
FinishtI �O'--c/ —f/ v.,v v- �- By