24261 1121 ROLLINGDELL COURT
Building Permit Confirmed
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING
/PERMIT
Date------------ ----- -f-------------10------- 19.7.E Permit No-----�� 61..-------------------
The undersigned her makes application to the Plumbing I pecfor of the City of San Jose
fora permit to install u i pip i f e reverse side.
Exemption from r 6 i f r ' o nfrecfor's License is hereby claimed
by undersigned: es owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorizes icefi
San Jose City Business License #
I certify that in the performance of the worlrfor which this permit is issue shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER T --k (_7
ADDRESS �/ �� o��iN4 / e�� Loi No. /
USE OF BUILDING
I u 1 `'VALLEY PLUMB ............
280-30(9-73) / Signed---.__-- ----'--------'-- 1
r' U. BOX 5 d _ cnp-
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