504 (2) 1163 Elmsford e�
Building Permit Confirmed ❑
Not Required Q1—
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Dafe----------------- ��- -`�---- ... 19.7-2-. Permit Noy------------
The undersigned h eb a est fpl' m ing Inspector of the City of San Jose
for a permit 4o insf p m�g �for nd r t on the reverse side.
Exemption from r quire nt for late o Caaalifornia for Contractor's License�is hereby claimed
by undersigned: as owner ❑ statement filed G3 7 O�
Undersigned attests that his to of California Contractor's License
is in full force and effect and pro e y ufhorixes ea pl�'�fi9n./ �/
San Jose City Business Licenvry/(y/V/ /`-
1 certify that in the performance of the workfor which this permit is issuod I shall not employ'
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER 1A /7eSoA'
ADDRESS // 7 377 E:L17,57-Follk :�/1 Lot No.
USE OF BUILDING lC
260-to Signed .dc...124V...
1163 Elmsford (/ Ace
FIXTURES FIXTURES MAIN DRAIN
Water Heaters / Floor Drains Size Material
Water Closets Hoppers To I To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size Material
Lavatories Area Drains To Curb IPTo Main Sewer
Kitchen Sinks Water Leaders WATER SYSTEM
Dish Washers Trailer Space Size Material
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee p0
Washg Machines Drywell Main Drain Fee
WaterinTreat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Water Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee 2 ;nC;
TOTAL TOTAL FEE �, CIO
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines Outlets
Rough Size
Tested and Approved
Finish B
Y