23365 (2) Lofl6
PG N 3 7629 ELDERWOOD COURt
' Building Permit Confirmed—Q—
Not Required ❑
CITY OF SAN JOSE BUILDING- DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date----------------------------o-- -/L..--- 19-.7Z(- Permit No.---- - -{P---- ----.-.-----
The undersigned hereb ' me a ap I'calion to a Pl�irybing Inspector of the City of San Jose
for a permit to install pl s dra� 6{{ed on the reverse side.
Exemption from require nt or State of Cali or
for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his Stale oliforni C�t�rd ric e #
is in full Force and effect and properly ihorize �/+ �� n" 007 7 7
San Jose City Business License
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 / oNOeroSA// / NOtiJe5 ms
ADDRESS 7 259 ELderwoo4 Court Lot No. f 6
USE OF BUILDING R&S"device
280-30(9-73) Signed-CYOWL /-----` -<...................................
7629 ELDERWOOD, COURT CROWLEY CO.
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