69663 7561 Pe6tp6ct
Building Permit Confirmed e�
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date------------ ------------_.- ----- 1947 Permit No.......... ...... 9li b
The undersigned hereby makes application to the Plumbing Inspector of the City of Sen Jose
fora permit to install pluming/(5eues and/a rpipasflli}ad�eP'�E�e�erse side.
Exemption from requueme��nFFYFol/51ata•e Cnlifar'riia fo�r�CantraEfor's License is hereby claimed
by undersigned: as owner statement filed ❑/����
Undersigned attests that his State of California C6�4rac4or's License #
is in full force and effect and properly au4hor'izfs }hiss ppy4b}ion.
San Jose City Business License
I certify that in the performance of the work for whi h This permit is issued I shell not employ
any person in any ma er so as�as to violate the workmen's compensation laws of California.
OWNERri �/
ADDRESSTS�Io�
USE OF BUILDING
FORM 280-30 (REV. 3/661 IOM 11 31 Be - -:b.. ............
7561 Prospect
R UjF&W
FIXTURES FIXTURES MAIN DRAIN
.Wafer Heaters Floor Drains SizeMateria a�
Wafer Closets Hoppers To j 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 " Material
Waste Disposals / Swim Pool FEES
Wash Trays Indirect Wastes Fixture Feena
Washing Machines Drywell Main Drain Fee
Wafer Treat. Equip. Backflow Preventer Storm Drain Fee p p
Sinks Survey Wafer Sys. Fee
Dental Units S� �. Gas Piping Fee
�O
Drinking Fountains Survey
Permit Fee ,gyp
"^ Z' TOTAL TOTAL FEE a0 .�
INSP ' REPORT HOUSE GAS PIPING
Partial No. Lines Outlets Size 3/
411
Rough f� ,'� I. Tested and Approved 0 l,7
Finish /7 '0'7 /2(/ By
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