2880 7558 Tiptoe /
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBINGz 'and/or GAS PIPING/PERMIT
Date---`- --/-(J-------------------------- 197 Permit No.------�--d- [/---.-......---....
The undersigned hereby mekes a plica+ion to the Plu bin Inspec of the City of San Jose
for a permit to install plumbing f' u li �rse side.
Exemption from requirement o 0 o a r s License is hereby claimed
by undersigned: s own ❑ statement filed ❑
Undersigned attests that his State of Celifoinia Contr c ors License
is in full force and effect and properly authorizes }his app,'
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 �5 Jr / /f 4 C�eMA Lot No.
USE OF BUILDING��
28030 Signed----CLO (fLm 1p..M-----------------
15/ ��y7°`� Plummer
r7c;98 Tiptoe
c WGA a _f -4 DC n2 �1 O=, 0 � : oc9 !crT w E E a oo
o c o
R S E 3 2
0 0 O_y 0 Jr O S S N O p O S ry ry
m o
m
"I � N ff i N V' C Y' '• A N O N Jr y � C
N
Z
T
m
m
W9 w9 Wj Wy N 0
0 0 0 0 N O O O O
N N N
n. o m -�
�• � y N (� 01 A � � � �' m '" C c D � �
C) T o Z1 0 G T
mm c o_ in o A o D_
N 3 Z
0
m