14649 (2) 928 'Candlewood
'Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBI G and/or GAS PIPING PERMIT
Date----------------IC---'-� y................ 1915.: FermityyyNo-------L. ... — F ' ............
The undersignedexeb mak ppl do 40 �ylumby pecfor of City of San Jose
for a permit }o ins� in ix r p n e reverse side..
Exemption fro q� re a or if r a r n{rac{or's License is hereby claimed
by undersigned: as owner' statement filed ❑
Undersigned attests that his State of Ca ifornia Contractor's License #
is in full force and affect and pr perly eu4horixes this application.
San Jose City Business Lice o # ^
I certify that in the per(o o {hew cs p rm' coat! I shall not employ
any person in any maannner)so , /to ' to the workmen s compensa ion ews of California.
OWNER (/driY f�//��Anr�
ADDRESS &Y (&MAIWIJ Lot No.
USE OF BUILDING �3i�P
280-30(9-73) Signed //-----------------------
928 Candlewood . holland
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