21970 (2) 1177 CRESTLINE DR. /\
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or .GAS PIPIN�7G PERMIT
Date ................... ..L7............. 19.��.. Permit No._(�L-�.1..
The undersigned hWmakoir.Slice+io to PI m Inspector of }he City of San Jose
for a permit to installa ip so haside.
Esemp+ion from re of if r a or ontractor's License is hereby claimed
by undersigned: ner ❑ s+atement filed ❑
Undersigned attests that his State of alifornia Contractor's License # C 3
is in full force and effect andY ro erl a +his a li i n.
P P �, 7
' - San Jose City Business License #_ G
I certify that in the performance of t e work for which this permliT is sued I shall not employ )
any person in any ma n//or so as to violate the workmen's compensation laws of California.
OWNER �/7�
ADDRESS Ji 7 7 �fPS ]L / vt �/I Lot No.
USE OF BUILDING p
280-30(9-73) / Signed .. . .. ...{ �=-L
1177 CRESTLINE DRVti�,y�r�,.
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