43289 (2) 5825 solYinger Rd ,
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS �PIPING PERMIT
Date 15... � d...__..................... 19� Permit No......... —1' ...........
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plumbing fixtures and/or pipes listed on the reverse side.
Exemption from requirement for State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License #—72 k -3 0-6
is in full force and effea and properly authorizes this application.
San Jose City Business License # L�Oy8Y
I certify that in the performance of the work for which this permit is issued 1 shall not employ
any person in any manner so as to violate the workmen's compensa_tionn laws of California.
Job Address ��`� S �� . Lot No.
Owner UY,UE/Zf1 N 0 111,2arfL Tract No.
Permittee?=?%r%l C,ug r i" / G k!u '
USE OF BUILDINGx n. 84f /1 Signe l trx<.c.............
zeo-aotn
5825 Bollinger Rd Ciari Plumbinq
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