12189 1566 Primrose way
Building Permit Confirmed ❑
Not Required jzr/05
. CITY OF SAN JOSE V BUILDING DEPARTMENT
APPLLIICATIION? FOR PLUMBING and/or GAS PIPING PERMIT
Date..,..0. '.✓-.1 J-------------------- 19-71 /Permit No................` r` / .. ......
The undersigned herebe'- spa a f' 1 e he�P umm;In ` : no of the City of San Jose
for a permit to install pl bingm iaf r ndf r pi lie n 1 erre side.
Exemption from requirement f State o California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed �� q ryQ
Undersigned attests that his State of Californiaontrac G® Ee ( — 6 S /
kv
is in full force and effect and properly eutho�rzgs�Bii ep^pn tS
Ke
San Jose City Business License #_y r]''/ 7
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any m per so as to violate the workmen's compensation laws of California.
OWNER
ADDRESS G �n 2c CitiLot No. -3
USE OF BUILDING
280-30(9-73) ned ----- --------------
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