30572 916 SE PTEMBER DRIVE Building Permit Confirmed
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GA-7S PIPING PERMIT
LI
Dafe---✓. ---------- .---------------- 1927 Permit No.JS ---------------
The
- -
The
undersigned here makes applice tion to the Plumbing Ins ..to of the City of San Jose
for a permit fo insfall her;,
, s t' o revers. side.
Exemption from req r of at f or a o rector's License is hereby claimed
by undersigned: as owner ❑ statement filed 2 y'1,
Undersigned attests that his State of Cali Cont; L/
is in full force and effect and properly auth is a_ .o^
San Jose City Business License #
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER 0-n)Id F-Imq / n
ADDRESS _F/T_., 9 �J/�p� Jam/ • Lot No.
USE OF BUILDING l /
Signed.-.. ..--
,<F�-
280-401n
916 SEPTEMBER DRIVE LET GEORGE DO IT
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