9822 992 September drive ///���
(�/ Building Permit Confirmed ❑
/
Not Required 0
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPIINNGq PERMIT
Date.........
19y1'�.. Permit No............ ..J__.O`` -----........
The undersigned hereb li i o } for of the City of San Jose
for a permit togins}all pl as g reverse side.
Exemption from requiremen for State o California for Contractor's License is hereby claimed
by undersigned: as owns^ statement filed ❑
Undersigned attests that his State of California C /�or.�Licens
is in full force and effect and properly authorizes this ..
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_mann� so as to viol workmen's compensation laws of California.
OWNERn
ADDRESS %Q� /tiU� ��[ Lot No.
USE OF BUILDING \
280-30 59-73) f Signed-- --- - ----- ----- u-R.-�+�-L --lee)---------'
992 September drive caccamo
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