242601105 ROLLINGDELL COURT
CITY OF SAN JOSE
Building Permit Confirmed
Not Required ❑
VI BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PERMIT
��PIIPING
Date --------------------------./o.'...7 ----- 192(-, Permit No._�_.Y.Z ?-3........ ........
The undersigned hereb makes applicatio
to the Plumbing Inspector the City of San ,lose
for a permit to install u n fi n
es e o ars lido.
6emption from r u r to
al i a r c icense is hereby claimed
by undersigned: as owner ❑
statement filed ❑
Contractor's License #
Undersigned attests that his State of Califomia
is in full force and effect and properly authori
s p plicatio
San Jose City Business License
I certify that in the performance of the work for which this permit is issued I s e
of employ
any person in any manner so as to violate the
workmen's compensation laws of Califor
OWNER 7—
ADDRESS %� Sn/�i�%Cf
ADDRESS
�G��� �'{i Lot No.
USE OF BUILDING
f_IfBR,rn?ip`u..-----_...----
280-30(9-73) Signed
---A-&-1-.....
P. 0. BOX 524 - SANTA CL
PING
1105 ROLLINGDELL COURT
A & J VALLE
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