38079 1165 56. STELLINC ROAn
Building Permit Confirmed'
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date-------'.V V-0--U..... --------- 19./-7F Permit No. ...._....4&-7.7.................
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plumbing fixtures and/or pipes listed on the 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 Contractor's License #
is in full force and effect and properly authorizes this application.
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/compensaattion laws of California.
OWNER I/1/ - I—,Of IY Vy vyt WT:1
ADDRESS MCPS 5. �a Lot No.
USE OF BUILDING
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Signed ......10---._ ..- .. V0-401r
1165 SO. STELLING ROAD OWNER
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