23494 1183 STAFFORD
Building Permit Confirmed2
Not Required
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date--- -=l --- ... ..----............... 19� Permit No.. .` .7../..... .
The undersigned her makes application to the Plumbing Inspector of the City of San e
for a permit To ins+all �,,,{�a i torr }nd or asppIisie�on�the reverse side.
Exemption from requ rtrV�o> -elite is di Contrac+or's License is hereby claimed
by undersigned: as owner ❑ statement filed �J
Undersigned attests that his State of Califor}iretra }� Lic see—
.
is in full force and effect and properly authorial {hsia'p +fi6n
San Jose City Business License #—
I certify that in the performance of the work for which this perp t is issued I shall not employ
any person in any manner so as to violate 4 e orlmen's compensation laws of California.
OWNER
ADDRESS 12� 3 S/G Q/ Lot No.
USE OF BUILDING
280-30(9-73) Signed ��--------,--------------`---....-------'--....
G. u 1183 STAFFORD RC BLDRS
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