16968 (2) 1155 L'LI,=OM
�j Building Permit Confirmed L7/
Not Required
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
A q
Da+e � --.. .... •J....--------------. 197.5... Perms+ No.-- -------.-/.. ---
The and nad hereby�n esaffo�� Inspector of the City of San Jose
for a permit to n all pluel , t �jr o ip t the reverse side.
Exemption from requirement f State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filedd EL
�tq�
Undersigned attests that his Sfaof California Contractor's License #
is in full force and effect and pro pelly�fhorize 2 af�ptI fi n- /i
San Jose City Business License ��-#'' 7jj ,i Y
I certify that in the performance of the work for which this 15ermit is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER
ADDRESS � � �� ���ir���2� Lot No.
USE OF BUILDING 5
280-30(9-73) Signed - -)-------
1155 EL,A70�D DAIyE
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