34783 It Required
e iced Confirmed
3 G Nof Req aired ❑
CITY OF SAN JOSE f BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date-------`y./ // ----------- 19.70- Permit No.............7f---T� ��
The undersigned hereby s a pl' i } he ing cfor of the City
of Sen Jose
for a permit fo install plum in i reverse side.
Exemption from requirement for afe of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ 'fate ent filed ❑ / /
Undersigned attests that his Ste to of California C rs e
is in full force and effect and properly authorizes this Rp' alio` ,/
San Jose City Business License # � g —, 2 iz W
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any m�a ,yr so as to violate the workmen's compensation laws of California.
OWNER �it� Ij
ADDRESS f!7 /� rnli� f No.
USE OF BUILDING
Signed ...t� "i..LCL..I..- .CLL
826 SEPTEMBER
GERARD PLUMBIN 280-401"
10 DC o 2T O ONo D o e 07CrT co E f
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