23030 1128 ROLLINGDELL COURT
Building Permit Confirmed
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date---d�-p------------------------------------- 19Z..k Permit No,------ �r�O 5r ----------------------
The undersigned hereby make p lication to the Plumbin Ins e7 15c the City of San Jose
for a permit to ins{all plumbin fix eside.
40
Exemption from requireme o a i nie or Contractors License is hereby claimed
by undersigned: as ow er ❑ statement filed ❑
Undersigned attests that his State of California Cyy r �m�jj
is in full force and effect and properly autho iso, }hil9 jtO�2ronry/�/ `/
San Jose City Business License
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 'Tw-c h 74f
ADDRESS //-2-8 sncr Lot No.S!
USE OF BUILDING
280-30(9-73)
P. 0. BOX 529 — SANTA CLARA, CALKING
1128 ROLLINGDELL COURT A & J VALLEY PLUM
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