41290 (2)' 939 BUBB RD nn
Building Permit Confirmed I�l-
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOppR�� PLUMBING] and/or GAS PIPING PERMIT
Date----..3. -----....._.G.o............_. 19 /. Permit No.--- ---.°--..�-v----------------
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 F statement filed E] -
Undersigned attests that his State of al ifornia Contractor's License #
is in full force and effect and properly authorizes this application.
San Jose City Business License #
I certify that in }he performance of the work for which this permit is issued I shall not emp oy
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER J •• j'I !C/'LC //
ADDRESS 7 / eU ala Q1) • .. Lot No.
USE OF BUILDING SIA/ IS ��' -S/�sadcAL
Signe .- --- - --- - -- -- x --------------------
26o-461n
939 BUBB ,RD OWNER
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