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96545 (2) 7528 Dela Farge Building Permit Confirmed ❑ Not Required ❑ CITY OF SAN JOSE BUILDING DEPARTMENT APPLICATION FOR c�PLUMBING and/or GAS PIPING PERMIT Date--`---------------:3-------7-------. 1972.. Permit No-----�--&-Y,/V:S.. --------------- The undersigned h y ma plic tion to he Plu g Inspec}or of the City of San Jose for a permit to in sf p i r r a on the reverse side. Exemption From n f e if is r Confreclor's License is hereby claimed by undersigned: as owner ❑ statement filed ❑ Undersigned attests that his Stale of Cali is tractor ice is in lull Force and effect and properly euth x applic or San Jose City Business License # 2— _ �6 Lr�O I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to violate the workmen's compensation laws of California. - OWNER 1?1661,VS C ADDRESS 7 rZ � n��A F'g26 E Lot No. USE OF BUILDING 28030 � ` Signed L/ e. L�f '4. L-- .....------- --------- 7528 Dela Farge Ace Plumbing FIXTURES FIXTURES MAIN DRAIN Water Heaters Floor Drains Size Material Water Closets Hoppers I To Septic Tank Bath Tubs Sand Traps RAIN WATER DRAINAGE Showers - Urinals Size Material Lavatories Area Drains To Curb To Main Sewer Kitchen Sinks Water Leaders WATER SYSTEM Dish Washers Trailer Space Size Fmaterial Waste Disposals Swim Pool FEES Wash Trays Indirect Wastes Fixture Fee ' /, p o Washing Machines Drywell - Main Drain Fee Water Treat. Equip. Backflow Preventer Storm Drain Fee ' Sinks Survey Water Sys. Fee Dental Units Gas Piping Fee Drinking Fountains Survey Permit Fee Z, p TOTAL TOTAL FEE ,3 vn INSPECTOR'S REPORT HOUSE GAS PIPING Partial No. Lines Outlets Size Rough Tested and Approved Finish By