24260 1115 ROLLINGDELL COURT
Building Permit Confirmed-ems
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPINGPERMIT
Date-----------...-----'��...:...7.--- ---. 19. �Permif No...._ vZ�-v-------------.-..
Thundersigna ere y ma p�eatio to I r ing Inspector,of the City of San Jose
fora permit to all u i s o a i e reverso side.
Exemption fro ra a nt for alife n for n#rac#ors License is hereby claimed
by undersigned: as owner ❑ statement filed
Undersigned attests that his State of C n onfra r L' s G
is in full force and effecturines and properly au f ri e ��
San Jose City Business License #'
1 certify that in the performance of the 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
ADDRESS ///� /P��/lJ�i /��� Lot No. /�
USE OF BUILDING_s!T
280-30(9-73) Signed----A A & J VA!"LL--- PLUMBING--.----_--..-----.
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