19269 923 Rose Blossom
s rJ Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPIN/G PER/MITT
Date. -. 7.1.x--)-)--_.................. I 4. Permit No.---.--.im----------1-.��- ---- ..--
The undersigned hereby m es a _ 9 o PI inc of }he City of San Jose
for a permit to install plurr X16 r s e `�/eyr(rse side.
Exemption from requirement or efe o alifornia for on}rectors license is hereby claimed
by undersigned: as owner ❑ statement filed
Undersigned attests that his State of California f
Lic
is in full force and affect and properly authorizes thi ' n.
Sen Jose City Business License # ' �l�
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 viola} the workmen's compensation laws of California.
OWNER D M11
ADDRESS (/ Lot No.
USE OF BUILDING
......
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280-30 (9-73) . Signed .. ..� . — /�V- -- -- - - ----
e,923 Rose Blossom O�Ce1Sg.
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