71866 7585 Prospect Rd
Building Permit Confirmed ❑
Not Required X
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS P//IPIIN/G// PERMIT
Date-/0/i.y
---------------------------- 19�� Permit No.-------�C.O..IO.Y?....................
The undersigned hereby ekes a plica}ion to�,he Plumbing Inspector of the City of San Jose
fora permit to install lu ig�fF��s�anil/or/"i et i�st d� n 'e�eeyerse side.
Exemption from raquiremenF fo�S}a{e of Californib'r�Con}rac}ors License is hereby claimed
by undersigned: a7 owner ❑ statement filed,13
Undersigned attests that his State of California Contractor's License ��/�✓ �� /
is in full force and effect and properly
p,Gt�}_horixes }his 'I'icaTion.
San Jose City Business License # / �D. ?:7�� ��`/
I certify that in the performanc of the work for which this permit is issued I shall not employ
any person in a nn so a violate a workmeerjs compensa}' lows of Cali(ornie.
OWN R - /' -:6y de'
X75 J l -
ADD E `
USE OF BUILDING
FORM 260-30 10M 3/67. Sig ed-- - --------- -----------C-.�i–�—C.:G.-�`�.....
7585 Prospect Zupcic _
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size Material
Water Closets Hoppers To I 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 Fee
Washing Machines Drywell Main Drain Fee
Water Treat. Equip. Backflow Prevent Storm Drain Fee
Sinks Survey Wafer Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit FeejT!T,� Q
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
POrhal No. Lines Ouflets Size
Rough Tested and Approved
Finish
r /