29516 1215 STAFFORD
Building Permit Confirmed
Not Required ❑
CITY OF SAN JOSE / BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
/
Date._...7-.-)../. - ---- 1977. Permit No-------�.—J6-7.......-------
The undersigned hereby mpkes,apPlieefionR o.s}helurpbing�lnspecfor of the City of San Jose
for a permit to install plumbing/rime and Ndpipes �i} d�n6/++e reverse side.
Exemption from requirement for State of/California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed
Undersigned attests that his State of California Contt'rac :s Licenn
is in full force and effect and properly authorizes this apr �r. ion.
San Jose City Business License
I certify that in the performance of the work 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 SH'yVs ) L4�
_ r —
ADDRESS Lot No.
USE OF BUILDING ^1 144 14(- G
280-30 (9-73) Signed ........ - -4-- -/V&oi �
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