47396 1260 PRIMROSE WAY
Building Permit Confirmed ❑
Not Required
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBIN and/or GAS PIPINGPERMIT
Date...............--.. .......... c.------- I9�U Permit No. ./...v.--------------
Tha undersigned hereby rsek' I fion�fo^fh lursBirig�rispea}or of the City of San Jose
for a permit to install plu�li��ii fives ded/dor pip lisote40 s}he"'everse lido.
Eramption from requirement forfSfate of Celiforma for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests than his State of Cal o1e`Contrecfr.G,
is in full force and effect and properly aulhoiisesfRia'epp�re o4, (��Y
San Jose City Business License
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 toviolate the workmen's compensation laws of California.
n/
Job Address A ff ITC O W U Lot No.
Owner—0 YAo( Tract No.
Permittee
USE OF BUILDING Signed...v� (/. C�/}�IZ4fJ/,f
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1260 PRIMROSE WAY ACE
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