77480 7'i 7548 Wa(terford
Building Permit Confirmed El
Not Required LJ
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date....--.'(....,..:---1 -7---------------- 19L�- Permit No---------------7— .a._O
The undersigned hereby a p H ati n t the Pl u�mbing Inspector of the City of San Jose
for a permit }o install plu in {' p'! ss' d�f� roversa side.
Exemption from requirement for fete o Cali ornie fo rector's License is hereby claimed
by undersigned: a 'owner Tg statement filed ❑
Undersigned attests that his State of California ontractor's License #
is in full force and effect and properly authorisest is ap¢licetionyt� �, I
San Jose City Business License # ;!
I certify the} in the performance of the work for which this permit is issue I shell not employ
any person in an anner so as t violate the workmen's compensation laws of California.
OWNER i ,�/OFIE�Ty
ADDRESS
USE OF BUILDING \�4
,1\Signed_... _V�A,..tN'-- --- -------------`--
FORM 280-30 10M 1/66
7548 Waterford Doherty
FIXTURES FIXTURES MAIN DRAIN
Water Heaters / Floor Drains Size Material
Water Closets Hoppers To To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size Material
' Lavatories Area Drains To Curb To Main Sewer
Kitchen Sinks Water Leaders WATER SYSTEM
Dish Washers Trailer Space Size Material
Waste Disposals Swim Pool I FEES
Wash Trays Indirect Wastes Fixture Fee
Washing Machines Drywell Main Drain Fee
Water Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Water Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee i
TOTAL / TOTAL FEE /
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial
Rough No. Lines Outlets Size
Tested and Approved
Finish �h f1 By ..