7220 (2) 1187 Elmsford
Building Permit Confirmed ❑
Not Required .-2
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date------------------------ z- /2- ..... 19�- . Permit No............ -------------
The undersigned here y makes pplicat'o f he Pum i g� Inspector of the City of San Jose
for a permit to install u i xt o pi 3� I the reverse side.
Exemption from r e- or a of alifornia for Contractor's License is hereby claimed
by undersigned: es owner ❑ t. stafemant filed ❑� �/Z ,3 � .3
6
Undersigned attars that h' .State of California Contractor's License #{'
is in full force and effect and roPpVy authorix hi a ica+io
e ' c y N �/1 � /div
San Jose City Business Lib
I certify that in the performance of the work for which this ermit is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER 1-1A27EA tt)
ADDRESS Ile? e4M.sFe"` `' 7)2 Lot No.
USE OF BUILDING 2t-S
Signeda&..�Ue azo_tc [ '.'.^-
28030 (/
1187 E1ms6ordl Ace
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