40208 850 SEPTEMBER DRIVE PHoNE: 277-4581
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date.72'll.�� ......./............._... 19 gPermit No._...._-..y6.7...O... ...U.................
The undersigned hereby ma "11,i a Plumkjing I}}ppctor of the Ciiy of San Jose
for a permit to install plumbi g pes rut ;1/E./sN.J reverse side.
Exemption from requirement falifornm or Clo/ni/FaJctors License is hereby claimed
by undersigned: astatement filed ❑�
Undersigned attests that his Sfafe of Calif n} nfiac} any 7
is in full force and effect and properly'aJuthorire�y4 ippli P nJ V C
San Jose City Business License # Y�- �c'rT I �— - w
❑ I certify that in the performance of the work for which this permit is issued I shall not employ,
any person.
OWNER ��
ADDRESS 2`Z2 Lot No.
USE OF BUILDINGj
Signed .. .. .... !/ .... u- ---
cc"J/�t 280-401N -
850 SEPTEMBER DRIVE ACE
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