30631 902 SEPTEMBER DR
Building Permit Confirmed ❑
Not Required [.3--
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING ZPERMIT
Date------- .� . �------------------ 19.2? Permit No. .-Dv---G.�---j-----------
The undersigned hereb makes application fo 4he Plumb' g Inspec#or of the City of San Jose
for a permit to ins}all p m r ip ✓' 4e he reverse side.
Exemption from re or o if rola or n#rac#or's License is hereby claimed
by undersigned:' as owner ❑ statement filed — 7
Undersigned attests that his State of Califor ado Or
is in full force and effect and properly aufhoria flplicpM
San Jose City Business License
I certify that in the performance of the or(wp r7
fo which this permit is issued I shell not employ
any person in any manner s es fo r'oI fe the workmen's compensation laws of California.
OWNER
ADDRESS Lof No.
USE OF BUILDING n �q
SigneL6XSL/LL2-�1 .. .-r�+_� O /Q7
902 SEPTEMBER DR off/ Bio �" ' �QUMB
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