267881105 ROLLINGDELL'CT
n Building Permit Confirmed [l}�
(/II Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date ..r:Fa................................--... 19.7? Permit No.._ ....�_.C._7.cP�i.....
The undersigned her kes ap licafion to th Plumbin Inspector he City of San Jose
for a permit to instal u nsy�{u / I' n 4 a e ido.
Exemption from a wf�riVfy( a R'alif to or cense is hereby claimed
by undersigned: �s owner ❑ statement filed ❑
Undersigned attests that his State alif is Contractor's License Z8 �7o — c r'
is in full force and affect and properlyof aufhCori s plicati
San Jose City Business License # x/ "/ .0 /
I certify that in the performance of the work for which this permit is issued I s all not employ
any person in any manner so as to viola fe the workmen's compens scion laws of California.
OWNER
ADDRES!
USE OF BUILDING 7"'0 lNnv ao
280-30 (9-73) Signed ------- Apaches--Poems---t`�"-"`-��-��'�Lf�
7280 Blue Hill Drive
S
1105 ROLLINGDELL -CT
San
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