23030 1144 ROLLINGDELL COURT
Building Permit Confirmed 0—
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date--�a`�/-;FA---------------------- 19-------. Permit No.---------0-�V6l;e------------------
The undersigned here �biy¢^faspec#or of the City of San Jose
for a permit #o
,ns
pl� Pre o p7 a he reverse side.
Exemption from requirement or State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ sta#a it st
Undersigned attests that his State of Californ� c#or' e s ��
is in full force and effect and properly au#hgrifet is a pliccaa#�ion.� �7
San Jose City Business License # (��P—
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-2--f- C--
ADDRESS �� Lot No.
USE OF BUILDING s ��
1 --PIIIAAR
280-30\(9-13) Signed ....A.. -.1.�: �_� . ...,,.. -�� �7-------------------
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1144 ROLLINGDELL COURT A & J VALLE PihHING
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