14768 (2) '20&10 Cleo /�
VI Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN,.JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Dafe......----' - -- --�------------ 19 yJ Perrnif No.----- .. ":.-11----------------
The and ersig h e y S9bl' on nspac}or of the City of San Jose
for a permit t ,nst i d P. the reverse side.
Exemption aqui ment ate of Ca i rnia for Contractor's License is hereby claimed
by undersigned: as owner EDstatement filed LRS
Undersigned attests that his Stat of alifornia Contractor's Licenze �,�
is in full force and effect and prop y e onzaz 4his n. ,
San Jose City Business Licens Sy _�
I certify that i the performa re of the work for which this permit is iss I shall not employ
any person in any an r so t Violate the wor men's compensation laws of California.
OWNER �A
t
ADDRESS Lot No.
USE OF BUILDING
280-30(9-73) Signed ----- --------- - ---- ��'-�- --- -�-----
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