14768 (2) 20624 Cleo
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS/PIPING PERMIT
Date--------------- -------Z.. ............. 19�-—: Perrnif No.------ -=-!-------------
The undersigns arab me z a n lu nspecfor of the City of Sen Jose
fora permit to ' tel I b' g i d/ pi6�fhe reverse side.
Exemption f nt f r ate a rnra for o.fractor's License is hereby claimed
by undersigned: as owner ❑ statement filed _
Undersigned attests that his State �f CaaUffornia srpnfracfor's Licensa.#.
is in full fore and effect and props e� y?az t 'CSS fc91 j .
San Jose City Business License rpo—
1,certify that in the performance of the work for which this perm' is issued I shall not employ
an person in an ,anner so as t� vio ate f e workmen's compensation laws of California.
yOWNER /✓ 1//n
ADDRESS Z06 Z y Lot No.
USE OF BUILDING
280-30(9-73) Signed------.'-_ ` /Q U D'/"V1%
292 Cleo Apache Unlercfromid
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