35808 (2) 1193 CRESTLINE tVrve
)t� Building Permit Confirmed-fa'
Not Required ❑
CITY OF SAN JOSE q BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date---71AI- ...Q 19------- Permit No.... -Alloy ,
.......................................
undersigned e a e lic t' fo /Plum bin actor of the City of San Jose
for a permit fo inst i e /or ip ad reverso side.
Exemption from eq ra n ( 1e o ali ria"Fad
License is hereby claimed
by undersigned: as ownerX statement filed Cl
Undersigned a+tests t at his State of California Contractor's License #
is in full force and of{act a roperly authorizes this application.
San Jose City Business L' e
I certify That in the pe o e of the o J ' tl i p rm' ii Euod I shall not employ
any person in anytt--ma�nner es violate }hbl`workmen's compons on)4'Ws f California.
OWNER-_1�/nxil
ADDRESS 3 L' ES7r i tio-- Lot No.
USE OF BUILDING Rfs " AQQQ t OVA AP
Signed ..... .. . . . . .........
, 280-401n
OWNER
9�CRESTLINE
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