841171497 Plum Blossom
Building Permit Confirmed ❑
�j Not Required 3�
CITY OF SAN JOSE / BUILDING DEPARTMENT
I
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date ....:.ILO.7V"-----/ �-- -------. 1969.Permit No - -------g�-7--117 ----------------
The undersigned hereby/ meke*, p—pl'�efi;an o Plu n Inspector of the City of San Jose
for a permit
to
ins#al plrimb�ng�fnduf` po�' ` Otho reverse side.
Exemption from requirement ,for State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of California Confrac}ors,aaLiwnse #
is in full force and effect and properly auth i:9s�f)ilis1a ppl1icAe-tidh.
San Jose City Business License # 0 ` p 4' �
I certify that in the performance of }he work for which this pormit is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER ' 't -c d la
ADDRESS
Lot No.
USE OF BUILDING
r
28030 Aug. 69 Signed ------- /.-. ..... ...............
1497 Plum Blossom Langmanks Inc.
FIXTURES
FIXTURES
MAIN DRAIN
Water Heaters
Floor DrainsSize
Material
Water Closets
Hoppers
—fo--
I To Septic Tank
Bath Tubs
Sand Traps -
RAIN WATER DRAINAGE
Showers
Urinals
Size Material
Lavatories
Kitchen Sinks
Area Drains
Water Leaders
To Curb I To Main Sewer
WATER SYSTEM
Dish Washers
I Trailer Space
Size rMaterial
Waste Disposals
Swim Pool
FEES '
Wash Trays
Washing Machines
Indirect Wastes
Drywell
Fixture Fee ' UU
Main Drain Fee
Water Treat. Equip.
Backflow Pre ventei
Storm Drain Fee
Sinks
Survey
Water Sys. Fee
Dental Units
Gas Piping Fee
Drinking Fountains
Survey
Permit Fee
TOTAL
TOTAL FEE
REPORT
No. Lines Outlets Size
Rough o
l Tested and Approved pproved
..