30446 6033 SHADY GROVE DR Building Permit Confirmed ❑
Not Required Pr,
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLIC TION FOR PLUMBING
l�and/or GAS PIPING /PERMIT
Date........ . 1.V..... 19/./ Permit No.......� . .................
The undersigned, ereby makes a u i of the City of Sen Jose
for a permit to install plumbing fixtures a or s is e or e arsa side.
Exemption from requirement for State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ # ment 'I
Undersigned attests that his State of California Cent a ice
is in full force and effect and properly authorizes this applice#ion.
San Jose City Business License #
I certify that in the performance of thes.ork 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 o�
ADDRESS
USE OF BUILDING i
. Signed _...- ---.. ..� ---
C .. ..-- - -----/.. .. /-
,Mu'P
6033 SHADYGROVE DR O� /CSS E'('LU 6"
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