19270 1148 Scotland Drive
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION F77��OR PLUMBING and/or GAS PIPING PERMIT
MIT
Date--��:...1.-f!------------------ I7�. Permit No...----------/-q-Z-74
The undersigned hereby makes p'c t' to m Ins ec f iha City of San Jose
for a permit to install plumbing {'p� is{ side.
Exemption from requirement for Stat of California { r Confracto s License is hereby claimed
by undersigned: as owner ❑ stafemen} filed
Undersigned attests that his State
of California Co e s Lice a
is in full force and effect and properly aufhorizps/}hi;_ j/
San Jose City Business License # L�
I certify that in the performance of the ork for whichthis^� is issued I shall not employ
(� any person in any man ar so as to violate the workmen's compensation laws of California.
OWNER
ADDRESS Lot No.
c\ USE OF BUILDING
280-30(9-73) Signed -- -- ------- - �. .. ' -- .... ... .
1148 Scotland Drive Ace ��g.
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