9048 (2) 1040 Bubb
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE 17 BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date-------------------S-- --- ------- 197t Permit No.----------- �. -'...............
The undersigned hereby m s e p i � Inspector of the City of Sen Jose
for a permit }o install plumb' g i r the reverse side.
Exemption from require. t for fate of California for Contractor's License is hereby claimed
by undersigned: as owner [� /q Afd ❑Z8/ 3.7 C 3�
Undersigned attests that his State o{ o ac r e
is in full force and effect and properly authorizes this application. ye- G _2
San Jose City Business License #
I 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 I3&-RkY - C. O ,
ADDRESS /Uyo 136f0 ,3 Lot No.
USE OF BUILDING /� S
28030
Signed �( .2_0 .a- -----�---
........................
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