23029 1120 ROLLINGDELL COURT
Building Permit Confirmed—E
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPIN�jG PERMIT
Date---�'------�-------------------------- 19-74 Permit No. �---ae 1........................
The undersigned reby makes application to the Plumbing Inspector of the City of San Jose
fora permit to in 1 nn��/ s on the reverse side.
Exemption fro r p�'ry s"r"' d is or Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned aHosts that his State f rni o a pprr ��n0�5—�G
is in full force and effect and proper)
San Jose City Business License # 7 / ��07ory
I 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 Tr c 7� S7/_t5
ADDRESS //a� Lot No--3
a
USE OF BUILDING � - ' �
280-30E (sas) signed ._A & J VaL!_EY ('LUMBING
P. 0. B0;( 524 - SAf4TA CORA. CALM.
1120 ROLLINGDELL COURT A & J VALLEY PLUMBING
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