92103 (2)833 Cotton Wood
Building Permit Confirmed ❑
Not Required 1-1
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date .' ---------- ----------- - 19.7/ Permit No. ---- �CQ
The undersigned here ma s lice' n e� n In r of }he City of San Jose
for a permit 4o ins}all umb' i ure d ipe n} d r versa side.
P g
Exemption from re ui r }a of Cali orn e r or's License is hereby claimed
by undersigned:. es owner ❑ statement fileds/sM
Undersigned attests that his State of Ca' ornia Contractor's Licens �tJ
is in full force and effect and properly au}ho '(sj a li,/Q", //—��-
San Jose City Business License
e#y ICJI'^pIC-/ (/
I certify that in the performance of the work or which this permit is issue shall not employ
any person in any ner s as to Aiolafe the workmen's compensation laws of alifornia.
OWNER t fat /� -z& e- 19G IJi4e a
ADDRESS
USE OF B
26030
833 Cottonwood Zimmerman
No. Lines 0utle Size
FIXTURES
FIXTURES
MAIN DRAIN
Water Heaters
Wafer Closets
Bath Tubs
Showers
Floor Drains
Hoppers
Sand Traps
Urinals
Size Material /�.
To To Septic Tank
RAIN WATER DRAINAGE
Size Material
Lavatories
/ Area Drains
To Curb
To Main Sewer
Kitchen Sinks
Wafer Leaders
WATER SYSTEM
Dish Washers
Waste Disposals
Trailer Space
Swim Pool.
Size / Z Material /f!i
ES'
Wash Trays
Washing Machines
Indirect Wastes
Drywell
=FeeOO
Wafer Treat. Equip.
Backflow Preventer
Sinks
Dental Units
Survey
Av
Gas Piping Fee ..
Drinking Fountains I
EL��Permit
Survey
Fee v' Q
TOTAL
TOTAL FEE ' A,Q
No. Lines 0utle Size