17257 920 Sage Ct.
Building Permit Confirmed
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATTION/� FOR PLUMBING and/or GAS PIPING PERMIT
Date---. !. ....Lb 19-7 Permit No.----- ----- ---- --........
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The undersigned hereby makes app' a on to um in ppc}or of the City of an Jose
for a permit to instell plumbing fixtu s d if er e.
Exemption from requirement for ate o aliform for ontracfor L nse is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License
is in full force and effect and properly au}herires this ap isi' /l/�/���J/��/�/�,'�
San Jose City Business License # ;M "—rLJ�/—' - — b'
I certify that in the performance of the work for which this permit is issued I shall notyemploy
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER J+A
ADDRESS 9 Z O e- Gam ' /Lot No. 3�
USE OF BUILDING t2- �y
280-30(9-13) I �gned---......... -' f///J- //5�- -'--.��-,r�., d.......--.
920 Sage Ct. , "° " _ -�"�"ACHE
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