26923 (2) 7544 DE LA' FARGE
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS //PIPING PERMIT
Date----a`'--.�X:557------------------- 1-.922. Permit No.�_(C�-.���-�--
The undersigned her makes pli do o t tyro in for of the City of San Jose
fora permit }o install u r s reverse side.
Exemption from ra r or a of a i or ,a for Con rador's License is hereby claimed
by undersigned: as owner ❑ statement filed
Undersigned attests chef his SI of lifornie Conf cior's icensa
is in full force and effect end pro rl } orixas this
San Jose City Business License
I certify that in performance of the work for which this 'permit iv issu d 1 shell not employ
any person in any a�er so as to violate the workmen's compensation laws of California.
OWNER
ADDRESS �r of No.
USE OF BUILDING
280-30(8-73) Signed. ..... ------ ---
7544 DE LA FARGE ACE�0 s('
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