79643 (2) 1173 Elmsford
Building Permit Confirmed ❑
Not Required [.�►
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS�P7IPING PERMIT
February 26 19..69 Perrni+ No......._-./ K 41�
Date...----- -------
The undersigned hereby makes application #p fh lumbing Inspector of the City of San Jose
for a permit to installA iyjP�r i isfad on the reverse side.
Exemption from a ,e' e o a ma for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ 216217
Undersigned attests that his State of ornia #r t r' L'b e
is in full force and effect and properly n 2957
San Jose City Business License #
1 certify that in theperformance 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 Richard Jameson
ADDRESS 1173 Elmsford
USE OF BUILDING Residence
CULLIGAN WATER CONDITIONING
FORM 2e0-30 10M t/BB Signed_ ...OF-'LOS GATOS------.-------------------
611 UNIVERSITY AVE., L09 CATCf3, CALIF. 94030
1173 Elmsford PttjNj.T j a40
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size M
Wafer Closets Hoppers To Taterial
o 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 Material
Waste Disposals . • Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee
Washing Machines Drywell Main Drain Fee
Wafer Treat. Equip. ,00 Backflow Preventer Storm Drain Fee
Sinks Survey Wafer Sys. Fee 1.00
Dental Units - Gas Piping Fee
Drinking Fountains Survey
Permit Fee 2.00
TOTAL .00 TOTAL FEE 4.00
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial
No. Lines Outlets Size
Rough
Finish Tested and Approved
— B
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