29816 (2) 7577 BOLLINGER ROAD
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING
^�and/or GAS APING PERMIT
Da+eZb' .J.�ib.`. ....................... 19. ?Permit No...__._/Jfi�� .1"�4'
The undersigned here ekes i ation 1 the P 'ng Inspec}or of the City of San Jose
{ore permit to install pl b' g li f n r i s I' on the reverse side.
Exemption from requi S e ( f Contractor's License is hereby claimed.
by undersigned: a owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License # 7/ei(/�
is in full force and effect and properly au} orixes this application.
San Jose City Business License #_ it
I certify that in the performance of th vor or whi i e . is ,ye hell not employ
any person in any manner so as to violate the v rkmen's compensa ion I •s/o California.
OWNER (�_0,0604Z
ADDRESS BOCLl,v' A.6 Lot No.
USE OF BUILDING f>e .
Signed .. .. ..: .. -----
28o 401n
7577 BOLLINGER ROAD DU BON '
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