23031 1136 ,,`_ROLLING DELL-COURT
Building Permit Confirmed F.l
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date ---------------_........ 19.....--- Permit No.----------------a DrJ' ....--"----
The undersigned hereby m s applica 'on 4 }he Plum bin I pecfor of the City of Sen Jose
for a permit to install plumb' g x re / lis o 1 r e ida.
Exemption from require 1 of orn r a cense is hereby claimed
by undersigned: es ner ❑ statement filed '❑'
Undersigned attests that his State of Cal ifo Contractors License #?�Q Vr/6
is in full force and effect and properly authori t i_ lice}' xsr"
San Jose City Business License # /�'C`fC."T�'— �9as
1 certify that in the performance of thew k for which his permit is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER � r G - dr . sz� 157�{�
ADDRESS L--? 10 c �= Lot No.
USE OF BUILDING —57,-'t
280-30(9-13) I Signed .A_&. NW-L FY.QI IITAB.!NG-----------------------
P. 0. BOX 524 — S.0TA CLARA, CALIF.
1136 ROLLING DELL COURT A & J VALLEY PLUMBING
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