9597 992 September
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR
/PLUMBING
`J and/or GAS PIPING PERMIT ,
Date--------------------._.......61./_2... 191..7 Permit No .-7-----------------
The undersigned her makes a icafion to the P u Bing Inspector of the City of San Jose
for a permit fo ins}all u pi s Ad�tys reverse side.
Exemption from to f or a o ra ctor's License is hereby claimed
by undersigned: as owner Elstatement filed ❑
Undersigned attests that his State of Cali(( rnia Contractor's License # .29,7130
is in full force and effect and properly u} o�{s B appli �/•
San Jose City Business License #4�� �JL
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 CAcc,AmQ ^
ADDRESS C Se' embea DR Lot No. ,ZQ
USE OF BUILDING�7 �N4Ie tt�mk1I14 p
280-30 Signed .... . -.A Gne...-1-Oa Ls.-------_------....
992 September
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