23780 1137 ROLLINGDELL CT
Building Permit Confirma41E /
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date ,7�------------------
-�-�3 - - - -- I9.��.. Permit No...- ---
The undersigned h makes application to the Plumbing Ins ecfor of fha City of San Jose
for a permit to install m f' r pi f e reverse side.
Esemption from re of rr' ctor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his Sfefa of California f — 's n �i;—%r�
is in full force and effect and properly authorixas f icati
San Jose City Business License #
I certify that in the performance of the work for which this permit is issued 1 shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER 7jr
ADDRESS ii 97Z? c Lot No.
USE OF BUILDING S
A &INALLEY PLUMBING
280-30(9-73) Signed ...P. 0...X000------BO0.X X..525- .44------SANT---....A..-C-LARA,-.. ..C—A-LI--.F.---------
1137 ROLLINGDELL CT A & J VALLEY
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