23029 1104 ROLLINGDELL ^COURT
`�/ Building Permit Confirmed i]—
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPINGPERMIT
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PERMIT
Date-cis...-,1.---------------"---------.... 19'(aPermit No.--------o , �i?l
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The undersigned here a as a I' fio to the Plum g Inspe t City of San Jose
for a permit fo install um �f'1 s 1 s a o e e side.
Exemption from re NfnM�T a a r c License is hereby claimed
by undersigned: s owner statement filed ❑
Undersigned Vis that his Stat f California Contractor's License # -,26 0
is in full force and effect end proper rix s fhis a a},
San Jose Cify Business License
I certify that in the performance of f e work for which this permit is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER T'rG
ADDRESS //et' Lot No/
USE OF BUILDING
280-30(9-73) Signed....A..&A-VAILEY- TU1.RARN---------------....
P. 0. BOX 524 - SANTA CLARA, CALIF.
1104 ROLLINGDELL COURT A & J VALLEY PLUMBING
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