81751 1655 Saratoga-SunnyvaLe Rd.
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING
q and/or GAS PIPING PERMIT
Date......-6---- ----j -------..... M L.. Permit No.----------e�-/7
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Tha undersined hereb makes application to the Plumbing Inspector of the City of San Jose
fora permit tog install mb' {'1 s o //�sy''�'�`J/y,�'"versa side.
6empfion from re � orn iWeEfor's License is hereby claimed
by undersigned: I as owner ❑ statement filed ❑
Undersigned attests that his State of/Calif rni Contractor's License # 2 tF9 9'
is in fulan force and effectBusiness
and properly au0 Ks i W— A ,��
Sen Jose City Business Licens¢ # h/�y�
I certify that in the performance of the wor for which this permif is issuedI 'shall not employ
any parson in any mannfer so as to violate the workmen's compensation laws of California.
OWNER Pe / C 4 f/5/ --
ADDRESS ll 5- S/d/l r /o 9/J '— a A A Y(1.4 /c Rc,�,
USE OF BUILDING��S ��R��f L OT NjoA __
FORM 280-30 IOM 1/6e
Signed .........
- -
-- - -....... ---------------'
1655 Saratoga-Sunnyvale Rd. L.L. Jona JR.
_ FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size a Material
Water Closets Hoppers / To C K r f To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size Material
Lavatories Area Drains To Curb To Main Sewer
Kitchen Sinks Water Leaders WATER SYSTEM
Dish WashersTrailer Space Size r , Material
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee
Washing Machines Drywell Main Drain Fee _
Water Treat. Equip. Backflow Preventer Storm Drain Fee —
Sinks / Survey Water,Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee 2-
TOTAL
TOTAL v TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines Outlets Size
Rough _ Tested and Approved
Finish By