12711 7568 Waterford Dr.
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
/ z- 26 - /
Date.---------------------- ---------------...... 197y------ Permit No-------/a�---7.//----------------
The undersigned hereb ekes a lication to the Plumbing Inspector of the City of San Jose
fora permit to install pl% /or i a lis the rereno side.
Ezempfion from reor' men r fe o a n f on#rectors License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ Jkt .237 �• 'j&
Undersigned attests that his State of Californi W,12
s�ec4oy'��.yy�,j�
is in full force and effect and properly authorizes s p�pblic iXtM ru/�—O-/", 6 `J
San Jose City Business License #
1 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 7S6q 7F2 ro/r n ��L Lot No.
USE OF BUILDING
280-30(9-13) Signed CGCeIC GB---- -- ---...----------
'7568 Waterford Dr. Ace
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