74017 7621 Prospect Rd
hBuilding Permit Confirmed ❑
,. Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
/✓...� ............................ IWf �/ Permit No.---- y o / -7
/ �l 7- .. ... ......... .........
Date. ---------
The undersigned hereby pc�s application to the Plumbing lrzVctor of the City of San Jose
fora permit to, install plu�b�id fi u �a '!or pipe lsiedr�n the r varse side.
Exemption from requifeFien� If6 eio Californ,a ferrCon act's License is hereby claimed
by undersigned: aYwner a statement filed ❑
Undersigned attests that his 5tafe of California Contractor's License # Us
is in.full force and effect and properly authorizes Witapplitetion.
San Jose City Business License #
I certify that in the performance of the work for which this permit is issued I shell not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER c- /
ADDRESS
USE OF BUILDING /
FORM 200-30 IOM 3/67 Signed... ----------_-------------
7621 Prospect Rd Bohart
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size Materia!: 'L
Water Closets 3 Hoppers To To Septic Tank
Bath Tubs / Sand Traps I RAMY 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 frays Indirect Wastes Fixture Feel
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 O
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial �A No. Lines / Outlets Size
Rough Tested and Approved
Finish i .R By '