10003 7491 Tiptoe Lane q , ,
' Building Permit Confirmed(r]'
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Da#e,/.Ll 7 - -' ' ...... 19.(-. Permit No.- - IQOGl3--------------------
The undersigned hereb makes application to the Plumbing Inspector of the City of San Jose
for a permit to install pl n e o ! 'st the reverse side.
Exemption from req ' or o ali i onfractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ,_!S
Undersigned attests that his State of Califor rtractor
is in full force and affect and properly auth�ri�6�l'
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
ADDRESS 7'ty� / L GL'a/fi Lot No.
USE OF BUILDINGS
280.30(9-73) Signed. --..
� O�7
7491 Ti'Dtoe Lank
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