230311112 ROLLING DELLn.COURT
Building Permit Confirmed—Ej—
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date ---r r:...1..._---.._--------------...._--- 19ac. Permit No.---------------- ._------------
The undersigned eby makes appy anion to 1h P mbin speclor of the City of San Jose
for a permit to .n II p r n r pe a reverse side.
Exemption fr m or f o dor a r onfracfor's License is hereby claimed
by undersigned: as owner ❑ statement filed 06 /a
Undersigned attests than his Spof iCent
to 's i ansa J
is in full force and effect and properly
erlly e o s
San Jose City Business License
1 certify that in the performance of the work for which this permit is issued 1 shall not employ
any person in any manner so as to violate the workmen's compensation laws of California'.' ^
OWNER
ADDRESS ii'<c• a c7 Lot No. G�
USE OF BUILDING
280-3019-731 e-� Signed .A..8,TVALLEY..,111M51RG----------------------
P. 0. BOX 524 — SAKA CLARA, CALIF.
1112 ROLLING DELL COURT A & J VALLEY PLUMBING,
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