15064 (2) 1175 Crestline
Building Permit Confirmed ❑
Not Required
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
1
Date �'-
S� f
--- -V..):�'- -_.. --------------------
..-� 19-7-57- Permit No......---�------------- ------------------
The undersigned here I e f.S�.n�a
r PI y�'`!7�ng Inspector of the City of San Jose
for a permit tc install plu ion iha reverse side.
Exemption from requi f��ia Contractor's License is hereby claimed
by undersigned: a statement filed ❑
Undersigned attests that his State �Coi�tracf�s�ic sa
is in full force and affect and properly auth.rises ltlisl ip�fca i.I\ I
San Jose City Business License $E' �� U ' 1 V V `N
I certify that in the performance of the work for which this permit is issued I shell not of employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER Lra Qc,,vti, 0 , D D \
ADDRESS 1 \ Lot No.
USE OF BUILDING $19
280-30 (9-73) Signed ...�� /,.Z.f�- ,r\n-.--1��......
1175 Crestline erickson
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