39974 111J STAFFORD DRIV>; PHONE: 2]]-4581
Building Permit Confirmed ,}L�]�
Q Not Required LJ \
CITY OF SAN JOSE / BUILDING DEPARTMENT
APPLICATION, FOR PLUMBING and/or GAS PIPING PERMIT
�
Date... .�,Q"" �.�...�._ .. 19..? Permit No...._....._97_/....._ ,.../...----------...
The undersigned hereby ales application to the Plumbing Inspector of the City of San Jose
for a permit fo inzf all plu bwin§�i'xfYrez enor�pipes�isfe :on ih'te reverse side.
Exemption from req uireme>'"n!'f�PS�(-6f~C�alif7if.C��actor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License #'
is in full force and effect and properly authorizes fhi'*ap'—
pication.���)J�l��
San Jose City Business License $k �a —
❑ I certify that in the performance of the work for which this permit is issued I shell not employ
any person.
OWNER 1I
C ADDRESS Lot .No'.
�' ��cL2Tl na 9"ST'rf�
USE OF BUILDING
Signed "- -
280-401N
1113 STAFFORD DRIVE OWNER
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