41428 1283 STAFFORD DRIVE
Building Permit Confirmed ❑�
Not Required f7�`
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Dat - 2 5 ---- ...... 17. Permit No. -- --t
f' -........
The undersigned hereby makes application 4o the Plumbing Inspector of the City of San Jose
for a permit to install pjum jinn fi+}�re�j �or pipe> on the reverse side.
Exemption from raqusremen�or Safe o4C&ornia for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed C 6 JO
Undersigned attests that his Stela of CSllfornie'Conlectorjs/LieensgW
is in full force and effect and properly eu} orifi ss his gppliselion��
San Jose City Business License #
I certify that in the erformance of hh;work for which this permit is issued I shall not employ
any person in any mann r so as 4o viola}e the workmen's compensation laws of California.
OWNER
ADDRESS Lot No.
USE OF BUILDING
r
Signed'--.-/?,� -------------------
..:... !-/-o----- ..------.
G SC � lit/-("pO/A "�6-o 8o-401n
1203 STAFFORD DRIV E A. 3. .TFRMTTF
WOj NiE DC NST a 0N :C * :3E r Nw F F
qFE 3 _ A OJ d9OJ + JrO SS TOETAA
N
Z
T
m
m
W D CC D CCD m D AN G'fFy T '_^. Z ::E
9 y O
a aaA aG1 � -i a Np O m J 2T Z
A m T o A O F
� n � ; �• drl A
T --I D Try T T u�i T m A m T 3. -4T n
S — _. A r fD N T ° C) T o A O ° m O ° Z
J Nm 'N° m ' n � A Nm A A '° A o
mm N cO
A v m D Z
M
m