99756 (2) 6309 Bollinger Rd.
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Da+e------1---- ---/ --
... 97 Pe No;.,-.------
undersigned h eb a s pl' ion o thing Inspector of the City of San Jose
for a permit to install lu 4 o i s is on the reverse side.
Exemption from req " am
en+ or State of California for Contractor's License is hereby claimed
by undersigned: s owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License #
is in full force and effect properly autf rize i is a pli 6,fi
San Jose City Business e #
I certify that in the pe an a of th J o r v ch s p rmit is issued I shall not employ
any person in any manner s as t viola}e the workmen's compen .tion laws of California.
OWNER ti R /l S S e-19 '
ADDRESS �ri D /31l G /N 1" 1e 1?
Lot No.
sAAl 1"os
USE OF BUILDING 1 /CSIA4;rA/c 1:'-
280 30
:'28030 Signed
6309 Bollinger Rd. Musser
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size Material
Water Closets Hoppers- •-Tao— I 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 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
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines Outlets Size
Rough Tested and Approved
finish – (o A„(' ,n T]" By