30707 912 '9AGV COMT ^ Building Permit Confirmed ❑
0�'y}yhl' Not Required ❑
CITY OF SAN JOSE r BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS.PIPINGG PERMIT
Date..........?.-f./-.............. I9 � Permit No.---- -D.1.-..4/.....Z------
The undersigned hereby in fi.epps!ion }0 the Plumbing Inspector of the City of San Jose
for a permit to install plumbin fi r p' lio arse side.
Exemption from requirem of i o for= rs License is herfby claimed
by undersigned: as o or ❑ statement
fil#ad
Undersigned attests that his State of California Contractor's License
is in full force and effect and properly eufhorixas it licefion
San Jose City Business License #' s/.p�—p—p^ ///������ ��� '''l'./�^
I certify that in the performance of thew r/r which h s pa is d 1/(ball not employ
any person in any manne so as # oI to the workmen's compensation laws ofCalifornia.
OWNER �� h1
ADDRESS Lot No. .
USE OF BUILDING
Signe -- ----- -- ----- n
gyp, 80,401
912 :SAGE) COURT l� "1�"� L ACE PLUMBi>
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