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67404 J�8 Stafford- c Building Permit Confirmed ❑ Not Required ❑ CITY OF SAN JOSE BUILDING DEPARTMENT APPLICATION FOR PLUMBING and/or GATS PIPING PERMIT Date-- ........... 191. Permit No.----- ... ................. The undersigned hereby makes a plication o / rlumbin lmp.ofo, of the Ci} of San Jose for a permit to install plumbing fish'ghdpJpei}e x,ffj���se side. Exemption from roquiremeni for a California for ontractors License is hereby claimed by undersigned: as owner statement filed 0 ��4� Undersigned attests that his State of California Con}racfor's License is in full force and effect and properly au ixas ihi��p�lication. �^ /��^ San Jose City Business License # � �� � �/�J I certify that in the performance of the work for which this permit is issued III not employ any person in any rn r�as to violate the workmen's compensation laws of California. OWNER — ADDRESS ,I USE OF BUILDING 60 FORM 2B0-30 IREV. 3�6G1 IOM ned 1 l.0 F&W 1108 FIXTURES FIXTURES MAIN DRAIN Wafer Heaters / Floor Drains Size Material C Water Closets Hoppers To I To Septic Tank Bath Tubs / Sand Traps RAIN WATER DRAINAGE Showers 2 Urinals Size Material Lavatories Area Drains To Curb To Main Sewer Kitchen Sinks / Water Leaders WATER SYSTEM Dish Washers Trailer Space Size / /' Material Waste Disposals Swim Pool FEES Wash Trays / Indirect Wastes Fixture Fee �� .P© Washing Machines / Drywell Main Drain Fee Wafer Treat. Equip. Backflow Preventer Storm Drain Fee a,0 U Sinks .� / Survey Wafer Sys. Fee �/ . Dental Units Gas Piping Fee i�0 Drinking Fountains Survey Permit Fee TOTAL TOTAL FEE INSPECTOR'S REPORT j HOUSE GAS PIPING Partial _ - �.CC;fSGi.L✓, No. Lines Outlets o2 Size Rough b/ / '7 / < 7/,�� _ Tested and Approved ,2 /, 1;7 Finish -//-/y &'Ie. 7 - By AYl