23364rl 1044 TUSCANY PLACE
�/4-
CITY OF SAN JOSE
Building Permit Confirmeclln
Not Required ❑
BUILDING DEPARTMENT
APPLICATION FOR PLUMBING PLUMBIN//yyG/and/or GAS PIPI7NG/ PERMIT
Date -----...-----------71--Jl..--------. 19./Permit No.----- 1.--W--/-(%...
The undersigned hereb makes application to the Plumbing Inspector of the Cify of San Jose
for a permit to install pl/ df�f 1i on on the reverse side.
Exemption from requ em r e if6rhiS YaF Contractor's License is hereb claim
by undersigned: as owner ❑ sta}amen} filed ❑
Undersigned attests that his State of Califor actor �poys
is in full force and affect and properly authorize pIir ]/(/
San Jose City Business License #
I certify that in th,/f5;'rfprmance of the work for which this permit is issued I shall not employ
any person in any manners es to viol" ate theworkmen's c pensationlaws of California.
OWNER
ADDRESS _L0
USE OF BUILDING
280-30 (9-73) „ Signed ..
1044,TUSCANY,PLACE.
SC<7/J
CROWLEY*
No.
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