14929 (2) i 2db24 Cleo
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR P MBING and/or GAS PIPING PERMIT.
av
Date..- - - - - � 19..��ermrt No:.......1...-.._/ ---------------
The
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The undersigne hereby makes appl icatio to the lumbing Inspector of the City of San Jose
for a permit to s4 pl m fis4 s
or
reverse side.
Esamp4io f a al o ie r rector's License is hereby claimed
by undersigne as owner ❑ statement filed ❑
Undersigned attests hat his State of California Contractor's License #
is in full force and effect and properly J�hor' 4his a aim.
Sen Jose City Business License #(
I certify that in the performance aha ork for which this permit is issued I shall not employ
any person in any anner so as toy'olate the workmen's
compensation laws of California.
OWNER �� Pi
t_/ ( ro&�� i7//G
Lot No.
ADDRESS
USE OF BUILDING
280-30(9.73) Signed .-- -- ate---....... --r - -..----- .
20624 Cleo Apache Underground '
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