79019 1518 Primrose Ln 9
' Building Permit Confirmed U
Not Required E?
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Dafe. ���•.. ?, appi. �P�rTha undersigned hereby maation to fhe Plumbing Inspector of the City of San Jose
for a permit to install plumbing fixtures and/or pips listed on the reverse side.
Exemption from requirement for State of Calif rnia foi•Confra rsgLicens is aby claimed
by undersigned: as owner ❑ 1 sfa rR'�nf)file�
Undersigned attests that his State of California Con rector Li ansa
is in full force and effect and properly aut hiiapplication.
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 mann so as to violate the workmen's ompensation laws of California.
OWNER l J
ADDRESS
USE OF BUILDING -� !`
FORM 260-30 IOM 1/66 Sri go
1518 Primrose Ln � �j��
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size Material
Wafer Closets Hoppers To To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size Material
Lavatories Area Drains To Curb To Main Sewer
Kitchen Sinks Water Leaders WATER SYSTEM
Dish Washers Trailer Space Size FMaterial
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee /,
Washing Machines Drywell Main Drain Fee '
Water Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Water Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee
TOTAL TOTAL FEE . pd,
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial
Rough _ No. Lines Outlets Size
nish
Tested and Approved
Fi ..� d l- BY